Paediatric Neurology

Question 1

When a child present with headache, what examinations should be done ?

Answer 1

Growth parameters, OFC, BP.
Sinuses, teeth, visual acuity
Fundoscopy .
Visual fields (craniopharyngioma)
Cranial bruit
Focal neurological signs
Cognitive and emotional status

Question 2

What are some of the symptoms associated with childhood migraine?

Answer 2

Abdominal pain, nausea, vomiting.
Focal symptoms/signs before, during, after attack: Visual disturbance.
Aggravated by bright light/noise.
Relation to fatigue/stress.

Question 3

What are some of the symptoms of raised intracranial pressure ?

Answer 3

Aggrevated by activities that raise ICP i.e. coughing, straining at stool and bending.

Woken from sleep with headache +/- vomiting.

Question 4

Symptoms of analgesic overuse headache ?

Answer 4

Headache is back before allowed to use another dose.
Paracetamol/NSAIDs.
Problems with compound analgesics e.g. Cocodamol.

Question 5

What are the indications for neuro-imaging ?

Answer 5

Cerebral dysfunction.
Raised ICP.
New focal neurological deficit i.e. new squint.
Seizures especially focal.
Personality changes.
Unexplained deterioration of school work.

Question 6

What is the suggested management of Migraine ?

Answer 6

Acute attack - Analgesia and Triptans.

Preventative (At least 1/week) Propranolol, Amitryptyline and Valproate.

Question 7

What is the suggested management of TTH ?

Answer 7

Aim at reassurance no sinister cause.
MDT management.
Acute attacks: Analgesia.
Prevention: Amitryptyline

Question 8

What types of headaches require more investigation ?

Answer 8

Chronic progressive and acute.

Question 9

Define seizure/fit

Answer 9

Any sudden attack, variable cause.

Question 10

Define syncope

Answer 10

Faint (Neuro-cardiogenic mechanism)

Question 11

Define convulsion

Answer 11

Seizure where there is prominent motor activity.

Question 12

Define epileptic seizure

Answer 12

An abnormal excessive hyper synchronous discharge from a group of neurons.

Paroxysmal change in motor, sensory or cognitive function.

Question 13

Define epilepsy

Answer 13

A tendency to recurrent, unprovoked epileptic seizures.

Question 14

What is the difference between a tension type headache and a migraine ?

Answer 14

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.

Question 15

Name some forms of non-epileptic seizures in children

Answer 15

Acute symptomatic seizures due to acute insults.
reflex anoxic seizure
Syncope
Parasomnias
Psychogenic non-epileptic seizures (PNES)

Question 16

What is a Febrile convulsion?

Answer 16

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.

Question 17

What type of seizure is present if the child is jerking/shaking ?

Answer 17

Clonic
Myoclonic
Spasms

Question 18

What type of seizure is occurring if the child goes stiff?

Answer 18

Usually a tonic seizure

Question 19

What type of seizure would be occurring if the child falls during?

Answer 19

Atonic/tonic/myoclonic

Question 20

How do you make an epilepsy diagnosis ?

Answer 20

EEG
MRI Brain
Genetics
Metabolic tests

Question 21

How is epilepsy in children managed ?

Answer 21

Anti-epileptic drugs (AED)
Slow upward titration.

Vagus nerve stimulation.

Question 22

What drugs are used in the treatment of epilepsy ?

Answer 22

Sodium Valproate (Not in girls)
Levetiracetam
Carbamazepine (First line for focal epilepsy)

Question 23

What happens in a tonic clonic seizures?

Answer 23

Tonic comes first

The eyes are open

Question 24

What are 2 head size problems?

Answer 24

Macroencephaly

Microencephaly

Question 25

Definition of Microencephaly

Answer 25

OFC <2 SD = Mild
OFC <3 SD = Moderate/severe

Microencephaly indicates small brain

Question 26

Definition of Macroencephaly

Answer 26

OFC >2SD

Question 27

What are the symptoms of Duchenne Muscular Dystrophy

Answer 27

Delayed gross motor skills.
Symmetrical proximal weakness (Waddling gait, calf hypertrophy)
Elevated creatinine kinase levels.
Cardiomyopathy