Paediatric neurology Flashcards
What history should be taken in a child with a suspected neuro problem?
Time course Static vs progressive Perinatal, developmental and FH Motor milestones Speech and language Early cognitive impairment Play Self help skills Vision and hearing assessment
What should be done on exam in a suspected neuro problem?
Appearance
Gait
Head size
Skin findings
What are the clinical types of headache?
Isolated acute
Recurrent acute
Chronic progressive
Chronic non-progressive
What should be taken in history of a recurrent or chronic headache?
Warning Location Severity Suration Frequency
What location of headache is a red flag in children?
Occipital
What should be done on exam in a child with headaches?
Growth parameters, head circumference, BP Sinuses, teeth, visual acuity Fundoscopy Visual fields Carotid bruit Focal euro signs Cognitive emotional status
What are the features of a migraine in a child?
Associated abdominal pain, N&V Focal S&S- visual disturbance, paraesthesia, weakness Pallor Photo and phono sensitivity Relation to fatigue/stress Helped by sleep, rest, dark FH
What is th management of acute migraine?
Effective pain relief- triptans
What is the preventative management of migraines and when is it given?
At least 1 a week Propanolol Amitryptyline Topiramate Valproate Pizotifen
What are the features of tension headaches?
Diffuse, symmetrical
Band like distrubution
Present most of the time, constant che
What is the management of tension headaches?
Reassure
Simple analgesia
Prevention- amitriptyline
Discourage analgesics in chronic
What are the features of a raised ICP headache?
Aggravated by activities that raise ICP= coughing, straining, bending
Woken from sleep with headache
What are the features of an analgesia overuse headache?
Headache back before allowed another dose
Paracetemol, NSAIDs, or particular problem with compound analgesics
What are the indications for neuroimaging with headaches?
Features of cerebella dysfunction Features of raised ICP Focal neuro deficit Seizures, esp focal Personality change Unexplained deterioration in school work
What are the common types of paroxysmal episodes in children?
Seizure
Convulsion
Febril convulsion
Syncope
What is a seizure?
Sudden attack from any cause
What is a convulsion?
Seizure with prominent motor activity
What is a febrile convulsion?
Convulsion associated with fever but without evidence of intracranial infection or defined cause of seizure
Usually between 3 months and 5 years old
What is epilepsy?
Tendency for unprovoked epileptic seizures
What is an epileptic seizure?
Abnormal excessive hyper synchronous discharge from a group of neurons
What is the mechanism of an epileptic seizure?
Chemically triggered by decreased inhibition, excessive excitation, excessive inflicting of Na and Ca ions
Chemical stimulation produces an electrical current
Summation of a multitude of currents result in depolarisation of many neurones, leading to a seizure
What are the types of epileptic seizure?
Partial
Generalised
What is the cause of the majority of childhood onset epilepsy?
Idiopathic
What are the common types of epileptic seizures in children?
Abscence
Myoclonus
Drop attacks
How is epilepsy diagnosed?
History Video recording of event ECG in cognitive seizures Interictal/ictal EEG MRI brain Genetics Metabolic tests
What is the management of epilepsy?
Anti-epileptic drugs Steroids Immunoglobulns Ketogenic diet- if resistant Vagus nerve stimulation Surgery
What are the options for anti-epileptic drugs?
Sodium valproate- first line in generalised in boys and non child bearing age girls Carbamazepine- first line focal seizures Levatiracetam Lamotrigine Perampanel
What are some types of non epileptic seizures?
Acute symptomatic seizures Reflex anoxia seizures Syncope Parasomnias Behavioural stereotypes Psychogenic seizures
What are acute symptomatic seizures due to?
Acute insults e.g. hypoglycaemia, trauma
When would you suspect a neuromuscular disorder?
Baby "floppy" from birth Slips from hands- lack of shoulder tone Paucity of limb movements Alert, but less motor activity Delayed motor milestones Able to walk but frequent falls
What are the features of NM disorders?
Poor balance Foot drop Toe walking Belly sticks out, lumbar lordosis Shoulder and arms held back when walking Wasting of thighs Myopathic fascies- ptosis, tent shaped mouth
What are the muscle causes of neuromuscular disorders?
Muscular dystrophies
Myopathies- congenital or inflammatory
Myotinic syndromes
What are the NMJ causes of NM disorders?
Myasthenic syndromes
What are the nerve causes of NM disorders?
Hereditary or acquired neuropathies
What are the anterior horn cells of NM disorders?
Spinal muscular atrophy
What are the features of neuropathy?
Distal weakness May have sensory signs Reflexes lost early Fasciculations No contractors or myocardial dysfunction
What are the features of myopathy?
Proximal weakness Usually pure motor Reflexes preserved until late No fasciculations Contractures Myocardic dysfunction
What are the features of Duchenne muscular dystrophy?
Delayed gross motor skills Symmetrical proximal weakness Waddling gait, calf hypertrophy Gower's sign + Elevated creatinine kinase Cardiomypathy Resp involvement in teens
What is Gower’s sign?
Get child to stand from lying
Shows pelvic girdle weakness
