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Paediatrics > Paediatric neurology > Flashcards

Paediatric neurology Flashcards

1
Q

What is the most important aspect of diagnosing neuro problem?

A

History

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2
Q

When does the majority of brain growth take place?

A

First 2 years of life

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3
Q

What are causes of neuro pathologies?

A

Congenital anomalies
Neurogenetic diseases and syndromes
Neurometabolic diseases and syndromes
Acquired

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4
Q

How can neuro problems be acquired?

A

Infection
Ischaemia
Trauma
Tumour

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5
Q

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

A

Static or slowly progressing

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6
Q

What do you want to find out in personal history?

A

Perinatal
Developmental
Family history

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7
Q

What should be examined in a child?

A 
Opportunistic approach and observation
Appearance
Gait
Head size
Skin findings
Real world examination depending on age
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8
Q

What are common neuro problems?

A 
Migraine/headaches
Traumatic brain injury
Tourette syndrome
Epilepsy
Brain tumours - second most common cancer in children
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9
Q

What do you want to find out about headaches?

A

Isolated acute
Recurrent acute
Chronic Progressive
Chronic non-progressive

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10
Q

What headaches are red flags?

A

Isolated acute - thunderclap

Chronic progressive

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11
Q

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

A 
More than 1 type?
Site
Severity
Any warning
Duration
Frequency
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12
Q

What causes loss of growth with headache?

A

Cranial pharyngioma

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13
Q

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

A 
Growth
Sinuses and teeth
Fundoscopy
Visual fields
Cranial bruit - murmur on ausculation on side of head
Focal neurological signs
Cognitive and emotional status
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14
Q

What is the purpose of examination of headache?

A

To determine if headache is primary or secondary

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15
Q

What features suggest migraine?

A

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

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16
Q

What is the main difference between tension headache and migraine?

A

Tension headache has no extra features

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17
Q

What are indications of raised ICP?

A

Aggravated by activities that raise ICP ie coughing

Woken from sleep with headaches

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18
Q

What are indications for neuroimaging?

A 
Features of cerebellar dysfunction
Features of raised ICP
New focal neurological deficit
Seizures esp focal
Personality change
Unexplained deterioration of school work
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19
Q

How is migraine treated acutely?

A

Effective pain relief

Triptans

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20
Q

How is migraine prevented?

A 
If there is at least 1 per week
Pizotifen
Propanolol
Amitryptiline
Topiramate
Valproate
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21
Q

How is tension headache treated?

A

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

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22
Q

How is seizure defined?

A

Any sudden attack of any cause - not just epilepsy

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23
Q

How is syncope defined?

A

Faint - neurocardiogenic

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24
Q

How are convulsions defined?

A

Seizure with prominent motor activity

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25
Q

What is an epileptic seizure?

A

Abnormal excessive hyper synchronous discharge from a group of cortical neurones

26
Q

What is epilepsy?

A

A tendency to recurrent, unprovoked/spontaneous epileptic seizures

27
Q

How is it decided if seizure is provoked?

A

Clinical history

28
Q

What triggers non-epileptic seizures?

A 
Acute symptomatic - hypoxia-ischaemia, hypoglycaemia, infection, trauma
Reflex anoxic seizures
Syncope
Parasomnias - night terrors
Behavioural stereotypes
Psychogenic non-epileptic seizures
29
Q

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

A

Febrile convulsion

30
Q

What is febrile convulsion?

A

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

31
Q

What types of seizure cause jerk/shakes?

A

Clonic
Myoclonic
Spasms

32
Q

What type of seizures cause stiffness?

A

Tonic

33
Q

What types of seizures cause falls?

A

Atonic
Tonic
Myoclonic

34
Q

What types of seizures cause vacant attack?

A

Absence

Partial seizure

35
Q

What chemically triggers epileptic fit?

A

Decreased inhibition
Excessive excitation
Excessive influx of sodium and calcium ions

36
Q

How is focal seizure defined?

A

Starts and is restricted to one hemisphere

37
Q

What is the stepwise approach to diagnosing epilepsy?

A 
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
38
Q

What is the main use of EEG in epilepsy?

A

Determine types of seizures

39
Q

What are investigations for epilepsy?

A

ECG for convulsions
MRI for aetiology
Biochemistry
EEG

40
Q

What is the role of antiepileptic medication?

A

Control seizures - not cure epilepsy

41
Q

What drugs are used in epilepsy?

A

Sodium valproate or levetiracetam are first line

Carbamazepine first line for focal seizures

42
Q

How can epilepsy be managed generally?

A

Medication
Vagal nerve stimulation
Epilepsy surgery

43
Q

What are the two main head size problems?

A

Macrocephaly

Microcephaly

44
Q

When should fontanelles of the skull close?

A

Posterior - 3 months

Anterior - 18 months to 2 years

45
Q

How is skull size measured?

A

Occipitofrontal circumference

46
Q

How are mild and severe microcephaly defined?

A

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

47
Q

How is macrocephaly defined?

A

OFC > 2SD from mean

48
Q

What causes extreme rate of head growth?

A

Fontanelles not closing

49
Q

What is plagiocephaly?

A

Flat head

50
Q

What is brachycephaly?

A

Short head or flat at back - common in Downs

51
Q

What is scaphocephaly?

A

Boat shaped skull

52
Q

What is craniosynostosis?

A

Cranial sutures fuse to early - single or multiple suture

53
Q

When should you suspect a neuromuscular disorder in a baby?

A 
Floppiness
Slips from hands
Paucity of limb movements
Alert but less motor activity
Delayed motor milestones
Able to walk but constant falls
54
Q

What gene is affected inDuchenne muscular dystrophy?

A

Xp21

55
Q

What are features of DMD?

A 
Delayed motor skills
Symmetrical proximal weakness - waddling gait
Elevated creatine kinase
Cardiomyopathy
Respiratory involvement in teens
56
Q

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

A

Neuropathy - distal weakness

Myopathy - proximal weakness

57
Q

How are sensory problems different in neuropathy compared to myopathy?

A

Neuropathy - concommitant sensory symptoms and signs

Myopathy - usually pure motor

58
Q

How are reflexes different in neuropathy compared to myopathy?

A

Neuropathy - reflexes lost early

Myopathy - Reflexes preserved till late

59
Q

Are fasciculations present in neuropathy or myopathy?

A

Neuropathy

60
Q

Are contractures a feature of neuropathy or myopathy?

A

Myopathy

Paediatrics (25 decks)

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