Paediatric Neurology Flashcards
What percentage of children age 10 - 17 suffer migraines?
7.7%
How can headaches be clinically evaluated according to their progression? Which presentations are more worrying?
Isolated acute - red flag
Recurrent acute
Chronic progressive - red flag
Chronic non-progressive
What type of headaches most commonly present as recurrent acute headaches?
Migraines
Tension-type headache
What investigations should be done to rule out underlying pathology in patients with headache?
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)
What pathology could cause reduced growth in conjunction with headache?
Pituitary tumour e.g. craniopharyngioma
- growth begins normally and then tails off
Describe the main features of a migraine
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
Describe the main features of a tension headache
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
What red flag symptoms indicate possible raised ICP?
Aggravated by activities that raise ICP eg. Coughing, straining at stool, bending
Woken from sleep with headache
Relieved later on in the day
What red flag symptoms indicate possible analgesic overuse headache?
Aggravated by activities that raise ICP eg. Coughing, straining at stool, bending
Woken from sleep with headache
Relieved later on in the day
What are the indications for neuroimaging in children?
• 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
What medications are used to manage an acute migraine attack?
Pain relief
Triptans
When is preventative medication indicated in migraine? What drugs can be used?
Only if headache occurs at least once per week
Pizotifen, Propranolol, Amitryptyline, Topiramate, Valproate
Describe the management options for tension headaches
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
What is an epileptic seizure?
An electrical phenomenon; abnormal excessive hypersynchronous discharge from a group of cortical neurones.
Causes a paroxysmal change in motor, sensory and/or cognitive function
What is convulsive status epilepticus?
Tonic-clonic seizures lasting 30 minutes or more