Paediatric Neurology Flashcards
what headache symptoms point to raised ICP?
- aggravatd by activites that raise ICP e.g. coughing, straining at stool, bending
- woken from sleep with headache +/- vomiting
what are indications for imaging for a headache presentation?
- features of cerebellar dysfunction
- features of raised ICP
- new focal neurological deficit e.g. new squint
- seizures, esp focal
- personality change
- unexplained deterioration of school work
migraine management
- acute attacks: effective pain relief, triptans
- preventative (at least 1/week): Pizotifen, Propanolol, Amitryptiline, Topiramate, Valproate
tension headaches treatment
- attention to underlying chronic physical, psychological or emotional problems
- acute attacks: simple analgesia
- prevention: amitryptiline
Epileptic Seizure definition
- An abnormal excessive hyper synchronous discharge from a group of (cortical) neurons.
- may have clinical manifestations
- paroxysmal change in motor, sensory or cognitive function
- depends on seizures location, degree of anatomical spread over cortex, duration
what are some non-epileptic seizure types and other mimics in children?
- acute symptomatic seizures: due to acute insults e.g. hypoxia-ischaemia, hypoglycaemia, infection and trauma
- reflex anoxic seizure
- syncope
- parasomnias e.g. night terrors
- behavioural stereotypies
- psychogenic non-epileptic seizures (PNES)
what is a febrile convulsion?
- A seizure occurring in infancy/childhood, usually between 3 months and 5 years of age, associated with fever but without evidence of intracranial infection or defined cause for the seizure.
- Commonest cause of ‘acute symptomatic seizure’ in childhood
what seizure types can cause the body to jerk/shake?
- clonic
- myoclonic
- spasms
what seizure type can cause the body to stiffen?
usually a tonic seizure
what seizure types can cause a fall?
- atonic
- tonic
- myoclonic
what seizure types can cause a vacant attack?
- absence
- complex partial seizure
Mechanism of epileptic fit
Chemically triggered by:
- decreased inhibition (GABA)
- excessive excitation (glutamate and aspartate)
- excessive influx of Na and Ca ions
Chemical stimulation produces an electrical current.
Summation of a multitude of electrical potentials results in depolarisation of many neurons which can lead to seizures, can be recorded from surface electrodes (EEG).
Epilepsy Diagnosis and Investigations
- history
- EEG
- MRI: if first seizure < 2 years old, focal seizures, no response to first-line anti-epileptic medications
Exclude pathology:
- ECG
- blood electrolytes
- blood glucose
- blood cultures, urine cultures, lumbar puncture
Epilepsy drug treatment option
- Sodium Valproate (not in girls) or Levetiracetam: first-line for generalised epilepsies
- Carbamazepine: first-line for focal epilepsies
- other therapies: steroids, immunoglobuline and ketogenic diet (mostly for drug-resistant epilepsies)
microcephaly definition
- OFC < 2SD: mild
- OFC < 3SD: moderate/severe
macrocephaly definition
- OFC > 2SD
when should you suspect a neuromuscular disorder in an infant/child?
- baby ‘floppy’ from birth
- slips from hands
- paucity of limb movements
- alert, but less motor activity
- delayed motor milestones
- able to walk but frequent falls
what causes Duchennes muscular dystrophy?
- caused by a defective gene for dystrophin on the X-chromosome.
- X-linked recessive inheritance.
Duchenne’s muscular dystrophy clinical presentation
- boys mainly affected
- present around 3-5 years with weakness in the muscles around their pelvis
- Waddling gait, calf hypertrophy, Gower’s sign positive
- the weakness tends to be progressive and eventually all muscles will be affected
- usually wheelchair bound by time they become teenager
- cardiomyopathy
- resp involvement in teens
