Paediatric Neurology Flashcards
What areas should be considered in a childs developmental history when taking a neurological history?
Gross and fine motor skill development
Speech and language development
Early cognitive development
Play and social behaviour
What should we loook out for on a neurological examination of a child?
- Appearance
- Gait
- Head size
- Skin
What are the most common neurological conditions children suffer with?
Migraine
Traumatic brain injury
Tourette syndrome
Epilepsy
Brain tumours
What are the different types of headaches that are most likely to have an underlying cause?
Isolated acute
Chronic progressive
What are the symptoms of childhood migraine?
Abdo pain, nausea and vomiting
Visual disturbance
Pallor
Aggravated by bright light/noise
Helped by sleep/dark quiet room
What are differences in pain experience in migraines compared to tension headaches?
Migraine = Hemicranial, throbbing/pulsatile pain
Tension = diffuse, symmetrical and band-like distribution
What features may indicate a headache caused by raised ICP?
- Headache agggravated by coughing, straining etc.
- Woken from sleep with headache
What would be the indications for imaging in paediatric headache cases?
1 - Signs of cerebellar dysfunction
2 - Signs of raised ICP
3 - Seizures
4 - Personality change
How are paediatric migraines treated?
Migraine:
- Pain relief
- Amitryptyline
- Propanolol
What is an epileptic seizure?
An abnormal excessive hyper synchronous discharge from a group of neurons
What is epilepsy?
A tendency to recurrent, spontaneous epileptic seizures
What is a febrile convulsion?
Occurs between 3 months and 5 years and associated with fever
What are the mechanisms by which epileptic fits occur?
1 - Decreased inhibition (GABA)
2 - Excessive excitation (glutamate and aspartate)
3 - Excessive influx of Na and Ca ions
What are the different types of epileptic seizures?
Partial
Generalised (most common)
How is seizure type, seizure syndrome and etiology identified?
EEG
How is epilepsy diagnosed?
From the history
Video of the event
ECG during seizures
EEG between seizures
Brain MRI
How are children with epilepsy managed?
Anti-epileptic drugs:
- Sodium valproate (generalised)
- Carbamazepine (focal)
Apart from medication, what other treatment options are available for epilepsy?
Vagal Nerve Stimulation
Surgery
What are the signs of a neuromuscular disorder in children?
Floppy baby
Objects slipping from hands
Reduced motor activity
Frequent falls when walking
What are the potential locations of an NMJ disorder in children?
Muscle
NMJ
Nerve
Anterior horn cell
Which gene is affected in duchenne muscular dystrophy?
Xp21 dystrophin gene
What are the clinical signs of duchenne muscular dystrophy?
1) Delayed gross motor skills
2) Symmetrical proximal weakness:
- Waddling gait
- Calf hypertrophy
- Gower’s sign +ve
3) Elevated creatinine kinase
4) Cardiomyopathy
What is the most likely cause of acute recurrent headaches?
Migraine
Which headaches are most likely to have a serious underlying cause?
Chronic progressive
