Paediatric neurology

Question 1

What is the most important aspect of diagnosing neuro problem?

Answer 1

History

Question 2

When does the majority of brain growth take place?

Answer 2

First 2 years of life

Question 3

What are causes of neuro pathologies?

Answer 3

Congenital anomalies
Neurogenetic diseases and syndromes
Neurometabolic diseases and syndromes
Acquired

Question 4

How can neuro problems be acquired?

Answer 4

Infection
Ischaemia
Trauma
Tumour

Question 5

What do you want to find out about onset of neuro conditions?

Answer 5

Static or slowly progressing

Question 6

What do you want to find out in personal history?

Answer 6

Perinatal
Developmental
Family history

Question 7

What should be examined in a child?

Answer 7

Opportunistic approach and observation
Appearance
Gait
Head size
Skin findings
Real world examination depending on age

Question 8

What are common neuro problems?

Answer 8

Migraine/headaches
Traumatic brain injury
Tourette syndrome
Epilepsy
Brain tumours - second most common cancer in children

Question 9

What do you want to find out about headaches?

Answer 9

Isolated acute
Recurrent acute
Chronic Progressive
Chronic non-progressive

Question 10

What headaches are red flags?

Answer 10

Isolated acute - thunderclap

Chronic progressive

Question 11

What should be asked specifically about each individual episode of headache?

Answer 11

More than 1 type?
Site
Severity
Any warning
Duration
Frequency

Question 12

What causes loss of growth with headache?

Answer 12

Cranial pharyngioma

Question 13

What should be done on examination of a child with a headache?

Answer 13

Growth
Sinuses and teeth
Fundoscopy
Visual fields
Cranial bruit - murmur on ausculation on side of head
Focal neurological signs
Cognitive and emotional status

Question 14

What is the purpose of examination of headache?

Answer 14

To determine if headache is primary or secondary

Question 15

What features suggest migraine?

Answer 15

Associated abdominal pain and nausea/vomiting
Focal symptoms/signs before, during, after attack - aura
Pallor
Aggravated by bright light and noise
Relation to fatigue and stress
Family history
Helped by sleep and dark quiet room

Question 16

What is the main difference between tension headache and migraine?

Answer 16

Tension headache has no extra features

Question 17

What are indications of raised ICP?

Answer 17

Aggravated by activities that raise ICP ie coughing

Woken from sleep with headaches

Question 18

What are indications for neuroimaging?

Answer 18

Features of cerebellar dysfunction
Features of raised ICP
New focal neurological deficit
Seizures esp focal
Personality change
Unexplained deterioration of school work

Question 19

How is migraine treated acutely?

Answer 19

Effective pain relief

Triptans

Question 20

How is migraine prevented?

Answer 20

If there is at least 1 per week
Pizotifen
Propanolol
Amitryptiline
Topiramate
Valproate

Question 21

How is tension headache treated?

Answer 21

Aim to reassure
Attention to underlying chronic physical, psychological, or emotional problems
Simple analgesia for acute attacks
Amitryptiline for prevention

Question 22

How is seizure defined?

Answer 22

Any sudden attack of any cause - not just epilepsy

Question 23

How is syncope defined?

Answer 23

Faint - neurocardiogenic

Question 24

How are convulsions defined?

Answer 24

Seizure with prominent motor activity

Question 25

What is an epileptic seizure?

Answer 25

Abnormal excessive hyper synchronous discharge from a group of cortical neurones

Question 26

What is epilepsy?

Answer 26

A tendency to recurrent, unprovoked/spontaneous epileptic seizures

Question 27

How is it decided if seizure is provoked?

Answer 27

Clinical history

Question 28

What triggers non-epileptic seizures?

Answer 28

``` Acute symptomatic - hypoxia-ischaemia, hypoglycaemia, infection, trauma Reflex anoxic seizures Syncope Parasomnias - night terrors Behavioural stereotypes Psychogenic non-epileptic seizures ```

Question 29

What is the most common cause of acute symptomatic seizure in childhood?

Answer 29

Febrile convulsion

Question 30

What is febrile convulsion?

Answer 30

Seizure occuring between 3 months and 5y of age associated with fever but without evidence of cranial infection

Question 31

What types of seizure cause jerk/shakes?

Answer 31

Clonic Myoclonic Spasms

Question 32

What type of seizures cause stiffness?

Answer 32

Tonic

Question 33

What types of seizures cause falls?

Answer 33

Atonic Tonic Myoclonic

Question 34

What types of seizures cause vacant attack?

Answer 34

Absence | Partial seizure

Question 35

What chemically triggers epileptic fit?

Answer 35

Decreased inhibition Excessive excitation Excessive influx of sodium and calcium ions

Question 36

How is focal seizure defined?

Answer 36

Starts and is restricted to one hemisphere

Question 37

What is the stepwise approach to diagnosing epilepsy?

Answer 37

``` Is the event epileptic in nature? Is it epilepsy? What seizure types are occuring? What is the epilepsy syndrome What is the aetiology What are social and educational effects on the child ```

Question 38

What is the main use of EEG in epilepsy?

Answer 38

Determine types of seizures

Question 39

What are investigations for epilepsy?

Answer 39

ECG for convulsions MRI for aetiology Biochemistry EEG

Question 40

What is the role of antiepileptic medication?

Answer 40

Control seizures - not cure epilepsy

Question 41

What drugs are used in epilepsy?

Answer 41

Sodium valproate or levetiracetam are first line | Carbamazepine first line for focal seizures

Question 42

How can epilepsy be managed generally?

Answer 42

Medication Vagal nerve stimulation Epilepsy surgery

Question 43

What are the two main head size problems?

Answer 43

Macrocephaly | Microcephaly

Question 44

When should fontanelles of the skull close?

Answer 44

Posterior - 3 months | Anterior - 18 months to 2 years

Question 45

How is skull size measured?

Answer 45

Occipitofrontal circumference

Question 46

How are mild and severe microcephaly defined?

Answer 46

Mild - occipitofrontal circumference <2 standard deviations from mean Moderate/severe - OFC <3 Standard deviations from mean

Question 47

How is macrocephaly defined?

Answer 47

OFC > 2SD from mean

Question 48

What causes extreme rate of head growth?

Answer 48

Fontanelles not closing

Question 49

What is plagiocephaly?

Answer 49

Flat head

Question 50

What is brachycephaly?

Answer 50

Short head or flat at back - common in Downs

Question 51

What is scaphocephaly?

Answer 51

Boat shaped skull

Question 52

What is craniosynostosis?

Answer 52

Cranial sutures fuse to early - single or multiple suture

Question 53

When should you suspect a neuromuscular disorder in a baby?

Answer 53

``` Floppiness Slips from hands Paucity of limb movements Alert but less motor activity Delayed motor milestones Able to walk but constant falls ```

Question 54

What gene is affected inDuchenne muscular dystrophy?

Answer 54

Xp21

Question 55

What are features of DMD?

Answer 55

``` Delayed motor skills Symmetrical proximal weakness - waddling gait Elevated creatine kinase Cardiomyopathy Respiratory involvement in teens ```

Question 56

How is the site of weakness different in neuropathy compared to myopathy?

Answer 56

Neuropathy - distal weakness | Myopathy - proximal weakness

Question 57

How are sensory problems different in neuropathy compared to myopathy?

Answer 57

Neuropathy - concommitant sensory symptoms and signs | Myopathy - usually pure motor

Question 58

How are reflexes different in neuropathy compared to myopathy?

Answer 58

Neuropathy - reflexes lost early | Myopathy - Reflexes preserved till late

Question 59

Are fasciculations present in neuropathy or myopathy?

Answer 59

Neuropathy

Question 60

Are contractures a feature of neuropathy or myopathy?

Answer 60

Myopathy