Paediatric Neurology Flashcards
When a child present with headache, what examinations should be done ?
Growth parameters, OFC, BP. Sinuses, teeth, visual acuity Fundoscopy . Visual fields (craniopharyngioma) Cranial bruit Focal neurological signs Cognitive and emotional status
What are some of the symptoms associated with childhood migraine?
Abdominal pain, nausea, vomiting.
Focal symptoms/signs before, during, after attack: Visual disturbance.
Aggravated by bright light/noise.
Relation to fatigue/stress.
What are some of the symptoms of raised intracranial pressure ?
Aggrevated by activities that raise ICP i.e. coughing, straining at stool and bending.
Woken from sleep with headache +/- vomiting.
Symptoms of analgesic overuse headache ?
Headache is back before allowed to use another dose.
Paracetamol/NSAIDs.
Problems with compound analgesics e.g. Cocodamol.
What are the indications for neuro-imaging ?
Cerebral dysfunction.
Raised ICP.
New focal neurological deficit i.e. new squint.
Seizures especially focal.
Personality changes.
Unexplained deterioration of school work.
What is the suggested management of Migraine ?
Acute attack - Analgesia and Triptans.
Preventative (At least 1/week) Propranolol, Amitryptyline and Valproate.
What is the suggested management of TTH ?
Aim at reassurance no sinister cause.
MDT management.
Acute attacks: Analgesia.
Prevention: Amitryptyline
What types of headaches require more investigation ?
Chronic progressive and acute.
Define seizure/fit
Any sudden attack, variable cause.
Define syncope
Faint (Neuro-cardiogenic mechanism)
Define convulsion
Seizure where there is prominent motor activity.
Define epileptic seizure
An abnormal excessive hyper synchronous discharge from a group of neurons.
Paroxysmal change in motor, sensory or cognitive function.
Define epilepsy
A tendency to recurrent, unprovoked epileptic seizures.
What is the difference between a tension type headache and a migraine ?
TTH :
A band around the head/non-specific, always there.
No symptoms with it.
Migraine: FH Visual and sensory symptoms. Nausea and vomiting. Specific location.
Name some forms of non-epileptic seizures in children
Acute symptomatic seizures due to acute insults.
reflex anoxic seizure
Syncope
Parasomnias
Psychogenic non-epileptic seizures (PNES)
What is a Febrile convulsion?
A seizure occuring in infancy/childhood usually between 3 months and 5 years of age, associated with fever but without evidence of IC infection or defined cause for the seizure.
What type of seizure is present if the child is jerking/shaking ?
Clonic
Myoclonic
Spasms
What type of seizure is occurring if the child goes stiff?
Usually a tonic seizure
What type of seizure would be occurring if the child falls during?
Atonic/tonic/myoclonic
How do you make an epilepsy diagnosis ?
EEG
MRI Brain
Genetics
Metabolic tests
How is epilepsy in children managed ?
Anti-epileptic drugs (AED)
Slow upward titration.
Vagus nerve stimulation.
What drugs are used in the treatment of epilepsy ?
Sodium Valproate (Not in girls)
Levetiracetam
Carbamazepine (First line for focal epilepsy)
What happens in a tonic clonic seizures?
Tonic comes first
The eyes are open
What are 2 head size problems?
Macroencephaly
Microencephaly
Definition of Microencephaly
OFC <2 SD = Mild
OFC <3 SD = Moderate/severe
Microencephaly indicates small brain
Definition of Macroencephaly
OFC >2SD
What are the symptoms of Duchenne Muscular Dystrophy
Delayed gross motor skills.
Symmetrical proximal weakness (Waddling gait, calf hypertrophy)
Elevated creatinine kinase levels.
Cardiomyopathy