Paediatric neurology Flashcards by Anna McCallum

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

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What should be done on exam in a suspected neuro problem?

Appearance
Gait
Head size
Skin findings

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What are the clinical types of headache?

Isolated acute
Recurrent acute
Chronic progressive
Chronic non-progressive

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What should be taken in history of a recurrent or chronic headache?

Warning
Location
Severity
Suration
Frequency

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What location of headache is a red flag in children?

Occipital

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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

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What are the features of a migraine in a child?

Associated abdominal pain, N&amp;V
Focal S&amp;S- visual disturbance, paraesthesia, weakness
Pallor
Photo and phono sensitivity
Relation to fatigue/stress
Helped by sleep, rest, dark
FH

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What is th management of acute migraine?

Effective pain relief- triptans

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What is the preventative management of migraines and when is it given?

At least 1 a week
Propanolol
Amitryptyline
Topiramate
Valproate
Pizotifen

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What are the features of tension headaches?

Diffuse, symmetrical
Band like distrubution
Present most of the time, constant che

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What is the management of tension headaches?

Reassure
Simple analgesia
Prevention- amitriptyline
Discourage analgesics in chronic

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What are the features of a raised ICP headache?

Aggravated by activities that raise ICP= coughing, straining, bending
Woken from sleep with headache

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What are the features of an analgesia overuse headache?

Headache back before allowed another dose

Paracetemol, NSAIDs, or particular problem with compound analgesics

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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

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What are the common types of paroxysmal episodes in children?

Seizure
Convulsion
Febril convulsion
Syncope

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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