Paediatric Neurology Flashcards
what are the most common types of primary headaches in children?
migraine
tension type headache
which patterns of a headache should be investigated in children?
- isolated acute headache
- chronic progressive headache
what patterns of headaches are seen in children?
- acute isolated
- acute recurrent
- chronic progressive
- chronic non-progressive
- new persistent daily headache
what differentiates migraine from tension type headaches in children?
- location (specific area vs generalised)
- severity (migraine severe, tension mild/moderate)
- type of pain (throbbing vs ache)
- effect on activities (migrain stops ADL, tension headache doesn’t)
- additional symptoms (migraine also presents with photophobia, vomiting, visual symptoms, weakness)
why is it important to measure growth in children with headaches?
because headache + stunted growth could be an indicated for craniopharyngioma
headache in which area of the brain is often more worrying?
headache in occipital area
name a few causes of secondary headaches in children
reduced visual acuity/eye strain sinus problems tooth decay/caries raised ICP tumours (rare)
what signs could indicate that a headache is caused by raised ICP in children?
- headache worse on coughing/straining
- child woken up in the night by headache + vomit
what signs could indicate that a headache is caused by overuse of painkillers?
- Hx of increased use
- headache returns before next dose allowed
when should a scan be done in children with a headache?
- if cerebellar dysfunction
- if raised ICP
- if new focal deficit (eg squint)
- behaviour changes
- decline in school work
- seizures
how are acute migraine attacks managed in children?
- rest/remove trigger
- pain relief
- tryptans
what drug is used for migraine prevention in children?
propranolol
how are acute tension type headaches managed in children?
reassurance
pain relief
how is tension type headache prevented in children?
amitryptiline
what is an epileptic seizure?
electrical disturbance in the brain causing synchronous firing of neurons in a specific area/all over the brain
what’s the difference between a tonic and an atonic seizure?
tonic seizure characteristed by stiffness/rigidity
atonic seizure is a sudden loss of tone
what is the difference between a clonic and a myoclonic seizure?
- clonic seizures characterised by rhythmic jerks
- myoclonic seizures are single jerks
define a myoclonic seizure
patient has split second, standalone jerks
what is a common characteristic of non-epileptic fits in children?
they are normally provoked
what are febrile convulsions?
seizures in children between 3 months and 5 years, caused in presence of a fever but no evidence of an intracranial infection (eg meningitis/encephalitis)
what is the first line treatment for focal epileptic seizures in children?
carbamazepine
what is the first line treatment for generalised seizures in children?
levetiracetam sodium valproate (boys only)
what seizures are common in toddlers, and what nerve is involved?
reflex anoxic seizures - mediated by vagus nerve
name a few causes of provoked seizures in children
hypoglycaemia
trauma
hypoxia
infection
what is a typical absent seizure?
abrupt loss of focus “daze”, short lasting, can involve eye rolling or flickering
what is a tonic-clonic seizure?
seizure characterised by onset of myoclonic jerks, then tonic rigidity of body followed by clonic rhythmic jerking
what differentiates a psychogenic seizure from an epileptic seizure?
in psychogenic seizures patient is alert and able to communicate, vs epileptic seizure where patient loses consciousness
what are psychogenic seizures often associated with?
underlying psychosocial issues
what characterises infantile spasms?
stiff arms and legs reach upwards, head bends forwards
occurs in infants under 12 months
what types of epileptic seizures exist?
partial/focal
generalised
which type of epileptic seizure is more common in children?
generalised seizure “grand mal”
what is the most common cause of epileptic attacks in children?
idiopathic, no underlying cause
why are EEGs not reliable methods of detecting whether a child has epilepsy?
because someone with epilepsy can have a normal EEG (false negative), or EEG can show activity in someone with no epilepsy (false positive)
what are the possible types of seizures seen in epilepsy?
- simple/complex partial seizures
- absent
- tonic seizures
- atonic seizures
- clonic seizures
- myoclonic seizures
- tonic/clonic seizures
what is status epilepticus?
epileptic seizure lasting longer than 5 mins
what is the use of EEGs in diagnosing epilepsy?
- identify type of seizures
- identify potential cause
- identify epileptic syndrome
what is VNS?
vagal nerve stimulation - device which sends electric shock to vagus nerve to stop epileptic seizure
at which age does the posterior fontanelle close in a child?
around 3 months
at which age does the anterior fontanelle close in a child?
1-3 years
what is the definition of microcephaly?
<2 SD (standard deviation) - mild/moderate microcephaly
<3 SD (standard deviation) - severe microcephaly
what is the definition of macrocephaly?
> 2 SD (standard deviation)
abnormalities of which head features can be found in children?
- head shape abnormalities
- head size abnormalities
what are the two types of head size abnormality in children?
microcephaly
macrocephaly
what causes head shape abnormalities in children?
abnormal closure of fontanelles
what types of abnormal head shape can be seen in children as a result of abnormal fontanelle closure?
brachycephaly (short head)
scaphocephaly (boat head)
plagiocephaly (flat head)
craniosynostosis
how is skull growth measured in children?
occipitofrontal circumference (OFC)
when is the occipitofrontal circumference (OFC) measured?
- as routine measurement every visit from birth to 3 years old
- if there is concern of neurological/developmental abnormalities
what does microcephaly normally indicate?
small/underdeveloped brain
what occurs in craniosynostosis?
fontanelles fuse too early, resulting in skull deformities
what is an important investigation to do if a child presents with weakness?
Creatine Kinase (CK)
what is Gower’s sign, and what disease is it commonly seen in?
sign of proximal weakness (especially of hips/thighs) which causes child to stand up using arms/hands
commonly seen in Duchenne’s muscular dystrophy
what is the genetic inheritance of Duchenne’s muscular dystrophy?
x-linked
name a few features of duchenne’s muscular dystrophy
- delayed gross motor skills
- proximal muscle weakness (pelvic/thigh)
- calf (pseudo)hypertrophy
- cardiomyopathy
- respiratory problems
- raised CK
what is myotonia?
inability to relax after voluntarily contracting a muscle
what is the most common inherited muscle disorder, and name one of its cardinal features
charcot-marie-tooth syndrome (hereditary motor/sensory neuropathy)
presents with pes cavus
what is the difference between myopathy and myodystrophy?
myopathy - muscle weakness
myodystrophy - muscle destruction
what are myasthenic disorders?
disorders that affect chemical signalling at NMJ
