Paediatric Neurology Flashcards
Name some paediatric neuro pathologies
Congenital abnormalities
Neurogenetic diseases and syndromes
Neurometabolic diseases and syndromes
Acquired: Infections, Ischaemia, Trauma, Tumour
Headache disorders affect … % of children by the age of 7, and ….% of children by age 15
In about 40% children by age 7, 75% of children by age 15
Clinical evaluation of headache in kids, name the 4 categories of onset
Isolated acute
Recurrent acute
Chronic progressive
Chronic non-progressive
Which onsets require a little more investigation? What are you worried about?
isolated acute
Chronic progressive
What could an isolated acute headache present with? what type of pain?
thunderclap
Chronic non progressive headache is characteristic of …
tension type headache
Recurrent or chronic headache history, what to ask?
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?
Headache examination, what do you do?
Growth parameters, OFC, BP Sinuses, teeth, visual acuity Fundoscopy Visual fields (craniopharyngioma) Cranial bruit Focal neurological signs Cognitive and emotional status
What is the goal of headache examination?
To find out if youre dealing with a primary or secondary headache
What is a primary headache?
headache with no underlying cause
what is a secondary headache?
headache secondary to another cause e.g. tumour
Pointers to childhood migraine
ABDO…
abdo pain, nausea, vomiting
Pointers to childhood migraine
Focal symptoms/ signs before, during, after attack:
visual disturbance, paresthesia, weakness
Pointers to childhood migraine, SKIN:
pallor
Pointers to childhood migraine, aggravated by
bright light/ noise
fatigue / stress
Pointers to childhood migraine, helped by
sleep/rest.dark, quiet room
Is family history often present in migraine?
YES, especially mother
Pointers to childhood migraine
what is the pain like?
Hemicranial, throbbing/pulsatile
How is tension type headache different to migraine?
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
Pointers to
Raised intracranial pressure are…
Aggravated by activities that raise ICP e.g. Coughing, straining at stool, bending
Woken from sleep with headache +/- vomiting
Pointers to analgesic overuse headache
Headache is back before allowed to use another dose
Paracetamol / NSAIDs
Particular problem with compound analgesics e.g. Cocodamol
Indications for neuroimaging in headache paeds
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
management of migraine -Acute Attack - includes..
effective pain relief
triptans
If more than 1 episode of migraine per week need to think preventative medication which include…
Propranolol B blocker
Aim of reassurance when managing Tension type headache is to explain…
that there is no sinister cause
Tension type headache management of acute attacks
simple analgesia
Prevention of tension type headache
amitryptiline
Other things to consider in tension type headache mamagement
MDT management
Attentions to underlying chronic physical, psychological or emotional problems
Discourage analgesics in chronic TTH
What is a seizure/ fit?
Any sudden attack from whatever cause
Syncope is
a faint (a neuro-cardiogenic mechanism)
What is a convulsion?
Seizure where there is prominent motor activity
many seizures are not …… in nature
epileptic
An epileptic seizure is an ….. phenomenon
electrical
Definition of an epileptic seizure
An abnormal excessive hyper synchronous discharge from a group of (cortical) neurons
What is epilepsy?
tendency to recurrent, unprovoked (spontaneous) epileptic seizures
Acute symptomatic seizures: due to acute insults e.g….
Hypoxia-ischaemia, hypoglycaemia, infection, trauma
Reflex anoxic seizure
common in toddlers
is provoked e.g. bump to the head
parasomnias
abnormal movements and stuff e.g. night terrors
Behavioural stereotypies
funny movement of younger kids
Psychogenic non-epileptic seizures (PNES)
epileptic seizure without the electrical activity - psychological in origin
Acute symptomatic seizure
commonest cause :-
Febrile convulsion which is….?
seizure occurring in infancy/childhood,
3months - 5 years
associated with fever but without evidence of intracranial infection or defined cause for seizure
Is Febrile convulsion common in childhood?
YASS BITCH
which type of seizure involve a jerk/ shake?
clonic, myoclonic, spasms
which type of seizure involve going stiff?
usually a tonic seizure
which type of seizure involve a fall?
Atonic / tonic / myoclonic
which type of seizure involve a vacant attack?
absence, complex partial seizure
Epileptic fits are chemically triggered by..
decreased inhibition (gama-camino-butyric acid, GABA) Excessive excitation (glutamate and aspartate) Excessive influx of Na and Ca ions
epileptic fits can be recorded through surface electrodes by …. because….
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
Types of Epileptic Seizures
partial seizure
generalised seizure
stepwise approach to diagnosis of epilepsy
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?
Helpfullness of EEG
identifying seizure types, seizure syndrome and aetiology
How to diagnose epilepsy
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
What drugs for epilepsy?
Anti-epileptic drugs (AED) should only be considered if diagnosis is clear even if this means delaying treatment
Does AED cure epilepsy?
No just controls seizures
What factors should be considered when selecting AEDs?
Age, gender, type of seizures and epilepsy
Side effects of AEDs
CNS related can be detrimental; Drowsiness, effect on learning, cognition and behavioural
first line drug treatment for generalised epilepsies…
Sodium Valproate or Levetiracetam
Carbamazepine is first line for
focal epilepsies
Other therapies for epilepsies
steroids, immunoglobulins and ketogenic diet
Vagal nerve stimulation
Epilepsy surgery
What is a fontanelle?
soft membranous gaps (sutures) between the cranial bones
Microcephaly definition mild…
and moderate/ severe…..
OFC < 2SD
OFC <3 SD
macrocephaly definition
OFC > 2SD
Pagiocephaly is
flat head
Brachycephaly
short head or flat at back
Scaphocephaly
boat shaped skull
Craniosynostosis
brain sutures close too early
When to suspect a Neuromuscular disorder…
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
classical sign of Duchenne’s muscular dystrophy
Gowers sign
