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Paediatrics > Paediatric Neurology > Flashcards

Paediatric Neurology Flashcards

1
Q

Which sections of a developmental history are important ?

A
  • Gross and fine motor skills
  • Speech and language development
  • Early cognitive development
  • Play: symbolic play and social behaviour
  • Vision and hearing assessment
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2
Q

How can a neurological exam be conducted in children?

A
  • Opportunistic approach and observational skills
  • Appearance
  • Gait
  • Head size
  • Skin findings
  • Real world examination
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3
Q

What are the four types of headache disorders?

A
  • Isolated acute
  • Recurrent acute
  • Chronic progressive
  • Chronic non-progressive
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4
Q

Which two types of headache disorders may require further investigation?

A
  • Isolated acute

- Chronic progressive

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5
Q

What things do you want to know about a headache?

A
  • Any warnings
  • Location
  • Severity
  • Duration
  • Frequency
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6
Q

What do you examine in a child presenting with headache?

A
  • Growth parameters, OFC and BP
  • Sinuses, teeth and visual acuity
  • Fundoscopy
  • Visual fields
  • Cranial bruit
  • Focal neurological signs
  • Cognitive and emotional status
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7
Q

Which features would suggest a childhood migraine?

A
  • Hemicranial pain
  • Abdo pain, nausea and vomiting
  • Focal symptoms/signs: visual disturbance, paresthesia and weakness
  • Pallor
  • Aggravated by bright light/noise
  • Relation to fatigue/stress
  • Helped by sleep/rest/dark and quiet room
  • Positive FH
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8
Q

Which features suggest a tension headache?

A
  • Diffuse and symmetrical headache
  • Band like distribution
  • Present most of the time
  • Constant ache
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9
Q

Which features of a headache suggest a raised intracranial pressure?

A
  • Aggravated by coughing, bending, straining at stool etc.

- Woken from sleep with headache +/-vomiting

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10
Q

Which features of a headache suggest an analgesic overuse headache?

A
  • Headache is back before another dose is allowed
  • Paracetamol/NSAIDs
  • Problem with compound analgesics e.g. cocodamol
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11
Q

What are the indications for neuroimaging in a child presenting with a headache?

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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12
Q

How can migraines be managed in children?

A
  • Acute: effective pain relief and triptans

- Preventative: pizotifen, propranolol, amitryptiline, topiramate and valproate

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13
Q

How can TTHs be managed in children?

A
  • Reassurance
  • MDT management
  • Attention to underlying problems
  • Acute: simple analgesia
  • Prevention: amitryptiline
  • Discourage analgesics in chronic TTH
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14
Q

What is an epileptic seizure?

A

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

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15
Q

Name some common non-epileptic seizures and other mimics in children

A
  • Acute symptomatic seizures due to acute insults e.g. hypoxia, hypoglycaemia, trauma etc.
  • Reflex anoxic seizure
  • Syncope
  • Parasomnias e.g. night terrors
  • Behavioural stereotypies
  • Psychogenic non-epileptic seizures
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16
Q

What is a febrile convulsion?

A

A seizure occurring in infancy/childhood, usually between 3 months and 5yrs, associated with fever but without evidence of intracranial infection or defined cause for the seizure

17
Q

Name some common features of seizures and the type of seizure they are associated with?

A
  • Jerk/shake: clonic, myoclonic and spasms
  • Stiff: usually tonic
  • Fall: atonic, tonic and myoclonic
  • Vacant attack: absence and complex partial seizure
18
Q

What is the mechanism of an epileptic fit?

A
  • Decreased inhibition of GABA
  • Excessive excitation
  • Excessive influx of Na and Ca ions
  • Chemical stimulation produces an electrical current
  • The electrical current results in depolarisation of many neurons which can lead to seizures
19
Q

Describe the stepwise approach to diagnosing 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 aetiology
  • What are the social and educational effects on the child
20
Q

How can epilepsy be diagnosed?

A
  • History
  • Video recording of the event
  • ECG in convulsive seizures
  • EEG
  • MRI Brain
  • Genetics
  • Metabolic tests
21
Q

How can epilepsy be managed in children?

A
  • Generalised: valproate or levetiracetam
  • Focal: carbamazepine
  • Other therapies: steroids, immunoglobulins and ketogenic diet
  • Vagal nerve stimulation
  • Surgery
22
Q

When do the fontanelles close?

A
  • Posterior: 2-3 months after birth

- Anterior: 1-3yrs of age

23
Q

What is microcephaly and what can cause it?

A
  • OFC < 2SD
  • Usually indicative of a small brain
  • Antenatal, postnatal, genetic and environmental
24
Q

What is macrocephaly and what else do you want to know?

A
  • OFC > 2SD
  • Suture closure, fontanelles, familial, hydrocephalus?, large brain and is development normal
  • Other physical abnormalities: facial features, hepatosplenomegaly, bony deformities etc.
25
Q

What is plagiocephaly?

A

Flat head (deformational type gives a parallelogram appearance)

26
Q

What is brachycephaly?

A

Short head or flat at the back

27
Q

What is scaphocephaly?

A

Boat shaped skull

28
Q

What is craniosynostosis?

A

When the bones in a babies skull fuse too early leading to a misshapen skull

29
Q

When should a neuromuscular disorder be suspected?

A
  • Baby is floppy from birth
  • Slips from hands
  • Paucity of limb movements
  • Alert, but less motor activity
  • Delayed motor milestones
  • Able to walk but frequent falls
30
Q

What are the features of duchenne muscular dystrophy?

A
  • X linked
  • Delaye gross motor skills
  • Symmetrical proximal weakness: waddling gait, calf hypertrophy and positive Gower’s sign
  • Elevated creatinine kinase
  • Cardiomyopathy
  • Respiratory involvement in teens
31
Q

Which features suggest a neuropathy?

A
  • Distal weakness
  • May have sensory signs
  • Reflexes lost early
  • Fasciculations may be present
  • No contractures or myocardial dysfunction
32
Q

Which features suggest a myopathy?

A
  • Usually proximal
  • Pure motor signs
  • Reflexes preserved
  • No fasciculations
  • Contractures
  • May have myocardial dysfunction

Paediatrics (17 decks)

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