Paediatric Neurology Flashcards

1
Q

What percentage of children age 10 - 17 suffer migraines?

A

7.7%

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2
Q

How can headaches be clinically evaluated according to their progression? Which presentations are more worrying?

A

Isolated acute - red flag
Recurrent acute
Chronic progressive - red flag
Chronic non-progressive

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3
Q

What type of headaches most commonly present as recurrent acute headaches?

A

Migraines

Tension-type headache

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4
Q

What investigations should be done to rule out underlying pathology in patients with headache?

A
Growth parameters including OFC
Blood pressure
Examine sinuses, teeth and visual acuity
Fundoscopy
Visual fields
Assess for cranial bruit
Assess for focal neurological signs
Assess cognitive/emotional status
CT/MRI (not done unless clear indication of pathology)
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5
Q

What pathology could cause reduced growth in conjunction with headache?

A

Pituitary tumour e.g. craniopharyngioma

- growth begins normally and then tails off

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6
Q

Describe the main features of a migraine

A
Hemicranial pain
Throbbing/ pulsatile
Abdo pain, nausea, vomiting
Relieved by rest esp in a quiet/dark room
Photophobia/ phonophobia
Visual, sensory, motor aura
Positive family history
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7
Q

Describe the main features of a tension headache

A
Diffuse, symmetrical
Band-like distribution 
Present most of the time (but there may be symptom free periods)
“Constant ache”
Does not usually limit activity
Does not respond well to paracetamol
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8
Q

What red flag symptoms indicate possible raised ICP?

A

Aggravated by activities that raise ICP eg. Coughing, straining at stool, bending
Woken from sleep with headache
Relieved later on in the day

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9
Q

What red flag symptoms indicate possible analgesic overuse headache?

A

Aggravated by activities that raise ICP eg. Coughing, straining at stool, bending
Woken from sleep with headache
Relieved later on in the day

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10
Q

What are the indications for neuroimaging in children?

A

• Features of cerebellar dysfunction
o Problem with gait or coordination
o Nystagmus
• Features of raised intracranial pressure
• New focal neurological deficit eg. new squint
• Seizures, esp focal
• Personality change
• Unexplained deterioration of school work
• Signs generally not interpreted in isolation

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11
Q

What medications are used to manage an acute migraine attack?

A

Pain relief

Triptans

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12
Q

When is preventative medication indicated in migraine? What drugs can be used?

A

Only if headache occurs at least once per week

Pizotifen, Propranolol, Amitryptyline, Topiramate, Valproate

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13
Q

Describe the management options for tension headaches

A
Aim at reassurance: no sinister cause
Multidisciplinary management
Attention to underlying chronic physical, psychological or emotional problems
Acute attacks: simple analgesia
Prevention: Amitryptiline
Discourage analgesics in chronic TTH
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14
Q

What is an epileptic seizure?

A

An electrical phenomenon; abnormal excessive hypersynchronous discharge from a group of cortical neurones.
Causes a paroxysmal change in motor, sensory and/or cognitive function

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15
Q

What is convulsive status epilepticus?

A

Tonic-clonic seizures lasting 30 minutes or more

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16
Q

What is epilepsy?

A

A tendency to recurrent, unprovoked (spontaneous) epileptic seizures

17
Q

What are the possible causes of non-epileptic seizures

A

Acute insults (acute symptomatic seizure)
Reflex anoxic seizures (mainly toddlers)
Syncope
Parasomnias (night terrors, sleep-walking)
Psychogenic non-epileptic seizures (NEAD)

18
Q

What type of seizure is a febrile convulsion?

A

Acute symptomatic seizure

19
Q

What types of insults can cause acute symptomatic seizures?

A

Any acute insult e.g.

  • hypoxia-ischaemia
  • hypoglycaemia
  • infection (esp meningitis)
  • trauma
20
Q

What age group are most susceptible to febrile convulsions?

A

age 3 months - 5 years

21
Q

Give seven types of seizure

A
  • Tonic
  • Clonic
  • Tonic-clonic
  • Myoclonic
  • Atonic
  • Absence
  • Complex partial seizure
22
Q

Give five examples of anti-epileptic drugs

A

Sodium valproate
Carbamazepine
Levatiracetam, Lamotrigine
Perampanel

23
Q

What signs might suggest a neuro-muscular disorder?

A
Baby is floppy from birth
Alert but decreased motor activity
Delayed motor milestones
Able to walk but falls frequently
Gower's sign
Myopathic facies
Myotonia
24
Q

What is Gower’s sign? Give one condition that is associated with a positive Gower’s sign

A

Demonstrate’s muscle weakness around the pelvic girdle

Duchenne’s muscular dystrophy

25
Q

What constitues “myopathic facies”?

A

Ptosis
Tented mouth
“Expressionless” face

26
Q

Give two ways to test for myotonia

A

Ask patient to clench fist then release

Ask patient to close eyes then release

27
Q

What are the main differences between myopathies and neuropathies?

A

Myopathy:

  • proximal weakness
  • purely motor signs
  • reflexes preserved until late
  • contractures present

Neuropathy

  • distal weakness
  • may be sensory signs as well as motor
  • reflexes lost ealy
  • fasciculations present (sometimes)
28
Q

What blood test finding indicates Duchenne Muscular Dystrophy?

A

Very high creatine kinase: >1000

29
Q

Describe the genetics of Duchenne Muscular Dystrophy

A

X-linked recessive