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Paeds > Paediatric Neurology > Flashcards

Paediatric Neurology Flashcards

1
Q

When does maximum head growth occur?

A

approx. 2 y / o

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2
Q

What is the young brain very susceptible to?

A

insult

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3
Q

What is symbolic play?

A

Pretend play

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4
Q

What is the second most common cancer in children?

A

Brain tumours

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5
Q

Types of headaches in childhood

A 
Isolated acute
Recurrent acute
- migraines
Chronic progressive
Chronic non progressive (TTH)
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6
Q

What is a red flag sign of a headache?

A

If the headache is localised to the back of the head

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7
Q

What is looked at in a headache exam?

A 
Growth parameters, OFC, BP 
Sinuses, teeth, visual acuity 
- sinusitis, carious teeth, headaches from visual problems 
Fundoscopy
- papilloedema
Visual fields (craniopharyngioma)
Cranial bruit
Focal neurological signs
Cognitive and emotional status
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8
Q

What would the identification of a bruit be indicative of in children?

A

AV fistula

Aneurysm

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9
Q

Examples of primary headaches in children

A

Migraine

Tension headache

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10
Q

Presentation of childhood migraine

A 
Pain 
- hemicranial 
- throbbing
- pulsatile
Nausea
Vomiting
Focal symptoms / signs
- visual disturbance
- paraesthesia
- weakness
Pallor
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11
Q

When can focal symptoms / signs of migraine occur in the attack?

A

During
Before
After

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12
Q

What are migraines aggravated by?

A

Bright light

Nosie

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13
Q

What are migraines related to?

A

Fatigue

Stress

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14
Q

What are migraines helped by?

A

Sleep
Rest
Dark
Quiet room

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15
Q

What is often found in the history of migraine?

A

FH

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16
Q

Treatment of childhood migraine

A 
Acute attack 
- effective pain relief 
- Triptans
Preventative (at least 1 week)
- Pizotifen 
- Propanolol 
- Amitriptyline
- Topiramate
- Valproate
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17
Q

What is a key feature of tension headaches?

A

Featureless and never severe

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18
Q

How often do tension headaches last?

A

They are there all of the time

But there may be symptom free periods

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19
Q

Features of pain in tension headaches

A

Diffuse, symmetrical pain
A band
Constant ache

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20
Q

Treatment of tension headahce

A 
Aim at reassurance; no sinister cause
Attention to underlying chronic, physical, psychological or emotional problems 
Acute attacks - simple analgesia 
Prevention 
- amitriptyline
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21
Q

What is discouraged in chronic TTH?

A

Analgesics

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22
Q

Clues to raised ICP

A 
Aggravated / increased by 
- coughing
- straining at stool 
- bending
Woken from sleep with headache
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23
Q

Features of analgesic overuse headache

A

headache is back before allowed to use another dose

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24
Q

What analgesics give analgesic overuse headache?

A

Paracetamol
NSAIDs
particular problem with compound analgesics e.g. cocodamol

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25
Q

Indications for neuroimaging

A 
Features of cerebellar dysfunction 
Features of raised ICP
New focal neurological deficit e.g. new squint
Seizures esp focal 
Personality change 
Unexplained deterioration of school work
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26
Q

What describes paroxysmal disorders?

A

Fits, faints and funny turns

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27
Q

Seizure vs convulsion

A

Seizure / fit = any sudden attack where there is prominent motor activity
Convulsion = Seizure where there is prominent motor activity

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28
Q

Pathology of an epileptic seizure

A

An abnormal excessive hyper synchronous discharge from a group of (cortical) neurones
Chemically triggered by imbalances in your neurotransmitters
- decreased inhibition (GABA)
- excessive excitation
- excessive influx of Na and Ca ions
Chemical stimulation produces an electrical current
Depolarising current can be measured on EEG
Paroxysmal change in motor, sensory or cognitive function

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29
Q

Definition of epilepsy

A

A tendency to recurrent, unprovoked / spontaneous epileptic seizures

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30
Q

How many seizures do you need to have to be diagnosed with epilepsy?

A

2 attacks

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31
Q

What is a partial / focal seizure?

A

Abnormal activity restricted to one hemisphere or part of the hemisphere

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32
Q

What is a general seizure?

A

Abnormal activity coming from both halves of the brain

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33
Q

When is an interictal EEG used?

A

When they are NOT having a seizure

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34
Q

EEG is used in identifying…

A

Seizure types
Seizure syndromes
Aetiology

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35
Q

Investigations for epilepsy

A 
History 
Recording of event 
ECG in convulsive seizures 
Interictal / ictal EEG
MRI  brain 
Genetics 
Metabolic tests
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36
Q

What does an MRI of the brain tell you about epilepsy?

A

The cause e.g. damage / aetiology

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37
Q

Treatment of epilepsy in children

A 
Anti-epileptic Drugs (AED)
- Sodium valproate (General)
- Carbamazepine (focal) 
Steroids
Immunoglobulins 
Ketogenic diet (mostly for resistant therapies) 
VNS (palliative procedure for treatment of epilepsy)
Surgery
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38
Q

S/Es of AED

A 
CNS related
Drowsiness
effect of learning 
cognition 
behavioural
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39
Q

Examples of non epileptic seizures

A 
Acute symptomatic seizures due to acute insults 
Reflex anoxic seizures
Syncope
Sleep Parasomnias e.g. night terrors
Behavioural stereotypes
Psychogenic seizures (NEAD)
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40
Q

Causes of acute symptomatic seizures

A 
Hypoxia-ischaemia
Hypoglycaemia
Infection 
Trauma
Pyrexia
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41
Q

Who is reflex anoxic seizure common in?

A

Toddlers

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42
Q

What triggers reflex anoxic seizures?

A

Pain
Upset
Fright

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43
Q

What does NEAD stand for?

A

Non epileptic attack disorder

44
Q

What is a febrile convulsion?

A

An event occurring in infancy / childhood, usually between 6 months and 5 years of age, associated with fever but without evidence of intracranial infection or defined cause for the seizure

45
Q

What is the commonest cause of acute symptomatic seizure in childhood?

A

Febrile convulsion

46
Q

Types of seizures

A 
Jerk / shake
- clonic = rhythmic
- myoclonic = one attack 
- spasms 
Stiff
- tonic seizure usually 
Falls
- atonic 
- hypertonia / tonic 
Vacant attack / absence / partial seizure
47
Q

Features of a myoclonic seizure

A

One attack
Fully aware but cannot control the jerks
Can be very subtle

48
Q

What happens in an atonic seizure?

A

Sudden drop of tone

49
Q

What is a risk of atonic seizures?

A

Injury

50
Q

What happens in a hypertonic seizure?

A

Sudden increase in tone

Posture maintained

51
Q

Presentation of a vacant attack / absence seizure

A

Acute onset
Eye flickering
Does not last long

52
Q

What are vacant attacks / absence seizures triggered by?

A

Hyperventilation

53
Q

What happens in a tonic clonic seizure?

A

Go blue

Go stiff

54
Q

What do neuromuscular disorders affect?

A

The peripheral nervous sysem

55
Q

Features of when to suspect a NM disorder

A 
Baby 'floppy' from birth 
Slips from hands
Paucity of limb movements
Alert but less motor activity 
Delayed motor milestones
Able to walk but frequent falls
56
Q

Presentation of NM disorders

A

Belly sticks out
Thin, weak thighs except from the front
Poor balance
- falls often
- awkward clumsy walking
Weak muscles in front of the leg cause “foot drop” and tip toe contractures
Tight heel cord (contracture) child may walk toes
Thick lower leg muscles (mostly fat and not strong)
Myopathic facies
Sway back
Shoulders and arms held back awkwardly when walking
Weak butt muscles (hip straightners)
Myotonia - difficulty in relaxing the muscles (eyes, fists)
Knees may bend back to take the weight
Very high foot arch - pess cavis
Hammar toes

57
Q

Features of myopathic facies

A

Ptosis
Cant close mouth due to shape
Lack of muscle control around mouth
Poor head position control

58
Q

NM muscle conditions

A

Muscle dystrophies
Myopathies congenital / inflammatory
Myotonic syndromes

59
Q

NM NMJ conditions

A

Myasthenic syndromes

60
Q

NM nerve conditions

A

Hereditary or acquired neuropathies

61
Q

NM anterior horn cell conditions

A

Spinal muscular atrophy

62
Q

Genes of Duchenne Muscular Dystrophy

A

Xp21

Dystrophin gene

63
Q

Who gets Duchenne Muscular Dystrophy?

A

Female carriers

Males have the disease

64
Q

Presentation of Duchenne Muscular Dystrophy

A 
Delayed gross motor skills
Symmetrical proximal weakness
- waddling gait (pelvic waddle)
- calf hypertrophy (replaced by fat)
- Gower's sign positive
Elevated Creatinine kinase 
- > 1000
Cardiomyopathy 
Respiratory involvement in teens
65
Q

What is creatinine kinase a measure of?

A

Muscular breakdown

66
Q

What value of creatinine kinase is normal?

A

200

67
Q

Treatment of Duchenne Muscular Dystrophy

A

Steroids

No cure

68
Q

Prognosis of Duchenne Muscular Dystrophy is what and depends on what?

A

With treatment can live to early 30s

Depends on gene type

69
Q

Characteristics of febrile seizures

A 
Temp > 38.4C
Age 6 months - 5 years
Peak 18 - 22 months 
Usually after 1 - 24 hours of recognised fever 
Seizure type is generalised or focal
70
Q

Two broad types of seizures

A

Typical

Atypical

71
Q

Features of a typical seizure

A

Generalised convulsion for < 15 mins

Single convulsion in one illness

72
Q

Features of an atypical seizure

A

Focal
Lasts for > 15 mins
Abnormal neurological signs
Developmental delay

73
Q

What condition protects against febrile seizures?

A

Gastroenteritis (apart from shigella)

74
Q

Does febrile seizures run in the family?

A

Yes

75
Q

Investigations of a seizure

A 
PLASMA GLUCOSE!
Electrolytes
CSF examination 
FBC
Neuroimaging
EEG
76
Q

Treatment of febrile convulsion

A

Antipyretics

77
Q

Do antipyretics reduce the risk of recurrence in febrile convulsions?

A

No

78
Q

Complications of febrile seizures

A

Todds paresis
Recurrent of FS
Epilepsy

79
Q

What is the chance of a febrile seizure happening again?

A

1 in 3

80
Q

Atypical febrile seizures increased he risk for developing epilepsy in the future by how much?

A

8-9%

81
Q

How long is a prolonged seizure?

A

5 mins or more

82
Q

Definition of an epileptic seizure

A

An electrical phenomenon in which an abnormally excessive synchronous discharge from a group of neurones (usually from cerebral cortex) occurs

83
Q

Definition of epilepsy

A

Tendency to recurrent, unprovoked, spontaneous epileptic seizures

84
Q

Definition of a symptomatic seizure

A

A seizure from a secondary cause e.g. brain tumour, hypoglycaemic etc

85
Q

Types of seizures

A 
Focal/partial
- simple (consciousness retained)
- complex (consciousness impaired)
- secondary generalised
Generalised
- absence
- myoclonic jerks
- tonic / clonic / GTC
- atonic / drop attacks
86
Q

Differential diagnosis of a seizure

A 
Reflex anoxic seizure
Vasovagal syncope
Breath holding attack 
Sleep related events (parasomnias)
GORD
Shuddering attack, temulousess/startles (hyperekplexia)
Benign positional vertigo 
Pseudo seizures
87
Q

1st line treatment for generalised epilepsy

A

Valproate

88
Q

1st line treatment for focal epilepsy

A

Carbamazepine

89
Q

Other treatments for seizures

A 
Steriods
IgS
Ketogenic diet
Vagus nerve stimulation 
Surgery
90
Q

Who gets reflex anoxic seizures?

A

Toddlers

91
Q

Pathology of reflex anoxic seizures

A

Triggers cause vasovagal overactivity

92
Q

Treatment for reflex anoxic seizures

A

None

93
Q

When do frontal lobe seizures particularly happen?

A

At night

94
Q

Features of GORD that look like a seizure

A

Babies arch their back and clench hands to prevent symptoms

95
Q

Features of infantile spasms

A

Repetitive

96
Q

Recovery of reflex anoxic seizures vs epileptic seizures

A

Reflex anoxic - rapid recovery

Epileptic - prolonged recovery

97
Q

What are the seizure patterns in west syndrome?

A

Infantile spasms

98
Q

When does west syndrome present?

A

First 4 - 8 months

99
Q

Which gender is west syndrome more common in?

A

Males

100
Q

What is west syndrome often associated with?

A

A serious underlying condition and carry a poor prognosis

101
Q

Presentation of west syndrome

A

Characteristic ‘salaam’ attacks; flexion of head, trunk and arms followed by the extension of the arms
Lasts 1 - 2 seconds but may be repeated up to 50 times
Progressive mental handicap

102
Q

Investigation of west syndrome

A

EEG - hypssarrhytmia in 2/3rds of infants

CT demonstrates against diffuse or local brain disease in 70% (e.g. tuberous sclerosis)

103
Q

Prognosis of west syndrome

A

Poor

104
Q

Treatment of west syndrome

A

Vigabatrin 1st line

ACTH

105
Q

Most common cause of headache in children

A

Migraine

Paeds (28 decks)

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