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Paeds AM > Paediatric neurology > Flashcards

Paediatric neurology Flashcards

1
Q

What history should be taken in a child with a suspected neuro problem?

A 
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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2
Q

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

A

Appearance
Gait
Head size
Skin findings

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3
Q

What are the clinical types of headache?

A

Isolated acute
Recurrent acute
Chronic progressive
Chronic non-progressive

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4
Q

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

A 
Warning
Location
Severity
Suration
Frequency
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5
Q

What location of headache is a red flag in children?

A

Occipital

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6
Q

What should be done on exam in a child with headaches?

A 
Growth parameters, head circumference, BP
Sinuses, teeth, visual acuity
Fundoscopy
Visual fields
Carotid bruit
Focal euro signs
Cognitive emotional status
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7
Q

What are the features of a migraine in a child?

A 
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
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8
Q

What is th management of acute migraine?

A

Effective pain relief- triptans

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9
Q

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

A 
At least 1 a week
Propanolol
Amitryptyline
Topiramate
Valproate
Pizotifen
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10
Q

What are the features of tension headaches?

A

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

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11
Q

What is the management of tension headaches?

A

Reassure
Simple analgesia
Prevention- amitriptyline
Discourage analgesics in chronic

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12
Q

What are the features of a raised ICP headache?

A

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

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13
Q

What are the features of an analgesia overuse headache?

A

Headache back before allowed another dose

Paracetemol, NSAIDs, or particular problem with compound analgesics

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14
Q

What are the indications for neuroimaging with headaches?

A 
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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15
Q

What are the common types of paroxysmal episodes in children?

A

Seizure
Convulsion
Febril convulsion
Syncope

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16
Q

What is a seizure?

A

Sudden attack from any cause

17
Q

What is a convulsion?

A

Seizure with prominent motor activity

18
Q

What is a febrile convulsion?

A

Convulsion associated with fever but without evidence of intracranial infection or defined cause of seizure
Usually between 3 months and 5 years old

19
Q

What is epilepsy?

A

Tendency for unprovoked epileptic seizures

20
Q

What is an epileptic seizure?

A

Abnormal excessive hyper synchronous discharge from a group of neurons

21
Q

What is the mechanism of an epileptic seizure?

A

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

22
Q

What are the types of epileptic seizure?

A

Partial

Generalised

23
Q

What is the cause of the majority of childhood onset epilepsy?

A

Idiopathic

24
Q

What are the common types of epileptic seizures in children?

A

Abscence
Myoclonus
Drop attacks

25
Q

How is epilepsy diagnosed?

A 
History
Video recording of event
ECG in cognitive seizures
Interictal/ictal EEG
MRI brain
Genetics
Metabolic tests
26
Q

What is the management of epilepsy?

A 
Anti-epileptic drugs
Steroids
Immunoglobulns
Ketogenic diet- if resistant
Vagus nerve stimulation
Surgery
27
Q

What are the options for anti-epileptic drugs?

A 
Sodium valproate- first line in generalised in boys and non child bearing age girls
Carbamazepine- first line focal seizures
Levatiracetam
Lamotrigine
Perampanel
28
Q

What are some types of non epileptic seizures?

A 
Acute symptomatic seizures
Reflex anoxia seizures
Syncope
Parasomnias
Behavioural stereotypes
Psychogenic seizures
29
Q

What are acute symptomatic seizures due to?

A

Acute insults e.g. hypoglycaemia, trauma

30
Q

When would you suspect a neuromuscular disorder?

A 
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
31
Q

What are the features of NM disorders?

A 
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
32
Q

What are the muscle causes of neuromuscular disorders?

A

Muscular dystrophies
Myopathies- congenital or inflammatory
Myotinic syndromes

33
Q

What are the NMJ causes of NM disorders?

A

Myasthenic syndromes

34
Q

What are the nerve causes of NM disorders?

A

Hereditary or acquired neuropathies

35
Q

What are the anterior horn cells of NM disorders?

A

Spinal muscular atrophy

36
Q

What are the features of neuropathy?

A 
Distal weakness
May have sensory signs
Reflexes lost early
Fasciculations
No contractors or myocardial dysfunction
37
Q

What are the features of myopathy?

A 
Proximal weakness
Usually pure motor
Reflexes preserved until late
No fasciculations
Contractures
Myocardic dysfunction
38
Q

What are the features of Duchenne muscular dystrophy?

A 
Delayed gross motor skills
Symmetrical proximal weakness
Waddling gait, calf hypertrophy
Gower's sign +
Elevated creatinine kinase
Cardiomypathy
Resp involvement in teens
39
Q

What is Gower’s sign?

A

Get child to stand from lying

Shows pelvic girdle weakness

Paeds AM (19 decks)

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