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Paediatrics > Paediatric Neurology > Flashcards

Paediatric Neurology Flashcards

1
Q

Name some paediatric neuro pathologies

A

Congenital abnormalities
Neurogenetic diseases and syndromes
Neurometabolic diseases and syndromes
Acquired: Infections, Ischaemia, Trauma, Tumour

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2
Q

Headache disorders affect … % of children by the age of 7, and ….% of children by age 15

A

In about 40% children by age 7, 75% of children by age 15

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3
Q

Clinical evaluation of headache in kids, name the 4 categories of onset

A

Isolated acute
Recurrent acute
Chronic progressive
Chronic non-progressive

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4
Q

Which onsets require a little more investigation? What are you worried about?

A

isolated acute

Chronic progressive

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5
Q

What could an isolated acute headache present with? what type of pain?

A

thunderclap

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6
Q

Chronic non progressive headache is characteristic of …

A

tension type headache

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7
Q

Recurrent or chronic headache history, what to ask?

A

Any warning? - visual disturbance
Location? - all over or font of the head - back of the head - more worrying

Severity? 0-10 - migraine is a 10
tension is less severe and can still go about day
Duration?
Frequency?

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8
Q

Headache examination, what do you do?

A 
Growth parameters, OFC, BP
Sinuses, teeth, visual acuity
Fundoscopy
Visual fields (craniopharyngioma)
Cranial bruit
Focal neurological signs
Cognitive and emotional status
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9
Q

What is the goal of headache examination?

A

To find out if youre dealing with a primary or secondary headache

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10
Q

What is a primary headache?

A

headache with no underlying cause

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11
Q

what is a secondary headache?

A

headache secondary to another cause e.g. tumour

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12
Q

Pointers to childhood migraine

ABDO…

A

abdo pain, nausea, vomiting

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13
Q

Pointers to childhood migraine

Focal symptoms/ signs before, during, after attack:

A

visual disturbance, paresthesia, weakness

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14
Q

Pointers to childhood migraine, SKIN:

A

pallor

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15
Q

Pointers to childhood migraine, aggravated by

A

bright light/ noise

fatigue / stress

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16
Q

Pointers to childhood migraine, helped by

A

sleep/rest.dark, quiet room

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17
Q

Is family history often present in migraine?

A

YES, especially mother

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18
Q

Pointers to childhood migraine

what is the pain like?

A

Hemicranial, throbbing/pulsatile

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19
Q

How is tension type headache different to migraine?

A

Tends to be featureless headache - non specific - almost present all the time and never goes away

TTH - diffuse, symmetrical
Band-like distribution
present most
Constant ache

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20
Q

Pointers to

Raised intracranial pressure are…

A

Aggravated by activities that raise ICP e.g. Coughing, straining at stool, bending
Woken from sleep with headache +/- vomiting

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21
Q

Pointers to analgesic overuse headache

A

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

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22
Q

Indications for neuroimaging in headache paeds

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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23
Q

management of migraine -Acute Attack - includes..

A

effective pain relief

triptans

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24
Q

If more than 1 episode of migraine per week need to think preventative medication which include…

A

Propranolol B blocker

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25
Q

Aim of reassurance when managing Tension type headache is to explain…

A

that there is no sinister cause

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26
Q

Tension type headache management of acute attacks

A

simple analgesia

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27
Q

Prevention of tension type headache

A

amitryptiline

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28
Q

Other things to consider in tension type headache mamagement

A

MDT management
Attentions to underlying chronic physical, psychological or emotional problems
Discourage analgesics in chronic TTH

29
Q

What is a seizure/ fit?

A

Any sudden attack from whatever cause

30
Q

Syncope is

A

a faint (a neuro-cardiogenic mechanism)

31
Q

What is a convulsion?

A

Seizure where there is prominent motor activity

32
Q

many seizures are not …… in nature

A

epileptic

33
Q

An epileptic seizure is an ….. phenomenon

A

electrical

34
Q

Definition of an epileptic seizure

A

An abnormal excessive hyper synchronous discharge from a group of (cortical) neurons

35
Q

What is epilepsy?

A

tendency to recurrent, unprovoked (spontaneous) epileptic seizures

36
Q

Acute symptomatic seizures: due to acute insults e.g….

A

Hypoxia-ischaemia, hypoglycaemia, infection, trauma

37
Q

Reflex anoxic seizure

A

common in toddlers

is provoked e.g. bump to the head

38
Q

parasomnias

A

abnormal movements and stuff e.g. night terrors

39
Q

Behavioural stereotypies

A

funny movement of younger kids

40
Q

Psychogenic non-epileptic seizures (PNES)

A

epileptic seizure without the electrical activity - psychological in origin

41
Q

Acute symptomatic seizure
commonest cause :-
Febrile convulsion which is….?

A

seizure occurring in infancy/childhood,
3months - 5 years
associated with fever but without evidence of intracranial infection or defined cause for seizure

42
Q

Is Febrile convulsion common in childhood?

A

YASS BITCH

43
Q

which type of seizure involve a jerk/ shake?

A

clonic, myoclonic, spasms

44
Q

which type of seizure involve going stiff?

A

usually a tonic seizure

45
Q

which type of seizure involve a fall?

A

Atonic / tonic / myoclonic

46
Q

which type of seizure involve a vacant attack?

A

absence, complex partial seizure

47
Q

Epileptic fits are chemically triggered by..

A 
decreased inhibition (gama-camino-butyric acid, GABA)
Excessive excitation (glutamate and aspartate)
Excessive influx of Na and Ca ions
48
Q

epileptic fits can be recorded through surface electrodes by …. because….

A

electroencephalogram (EEG)
because Chemical stimulation produces an electrical current
Summation of a multitude of electrical potentials results in depolarization of many neurons which can lead to seizures

49
Q

Types of Epileptic Seizures

A

partial seizure

generalised seizure

50
Q

stepwise approach to diagnosis of epilepsy

A

is the paroxysmal event epileptic in nature?
Is it epilepsy?
What seizure types are occurring?
What is the epilepsy syndrome?
What is the biology?
What are the social and educational effects on the child?

51
Q

Helpfullness of EEG

A

identifying seizure types, seizure syndrome and aetiology

52
Q

How to diagnose epilepsy

A

History
Video
ECG in convulsive seizures
Interictal/ octal EEG
MRI brain: to determine aetiology e.g. malformations/ brain damage
Genetics: idiopathic epilepsies are mostly familial; also single gene disorders e.g. Tuberous sclerosis
metabolic tests:es if associated with developmental delay/ regression

53
Q

What drugs for epilepsy?

A

Anti-epileptic drugs (AED) should only be considered if diagnosis is clear even if this means delaying treatment

54
Q

Does AED cure epilepsy?

A

No just controls seizures

55
Q

What factors should be considered when selecting AEDs?

A

Age, gender, type of seizures and epilepsy

56
Q

Side effects of AEDs

A

CNS related can be detrimental; Drowsiness, effect on learning, cognition and behavioural

57
Q

first line drug treatment for generalised epilepsies…

A

Sodium Valproate or Levetiracetam

58
Q

Carbamazepine is first line for

A

focal epilepsies

59
Q

Other therapies for epilepsies

A

steroids, immunoglobulins and ketogenic diet
Vagal nerve stimulation
Epilepsy surgery

60
Q

What is a fontanelle?

A

soft membranous gaps (sutures) between the cranial bones

61
Q

Microcephaly definition mild…

and moderate/ severe…..

A

OFC < 2SD

OFC <3 SD

62
Q

macrocephaly definition

A

OFC > 2SD

63
Q

Pagiocephaly is

A

flat head

64
Q

Brachycephaly

A

short head or flat at back

65
Q

Scaphocephaly

A

boat shaped skull

66
Q

Craniosynostosis

A

brain sutures close too early

67
Q

When to suspect a Neuromuscular 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
68
Q

classical sign of Duchenne’s muscular dystrophy

A

Gowers sign

Paediatrics (15 decks)

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