Paediatric Neurology Flashcards
Which sections of a developmental history are important ?
- Gross and fine motor skills
- Speech and language development
- Early cognitive development
- Play: symbolic play and social behaviour
- Vision and hearing assessment
How can a neurological exam be conducted in children?
- Opportunistic approach and observational skills
- Appearance
- Gait
- Head size
- Skin findings
- Real world examination
What are the four types of headache disorders?
- Isolated acute
- Recurrent acute
- Chronic progressive
- Chronic non-progressive
Which two types of headache disorders may require further investigation?
- Isolated acute
- Chronic progressive
What things do you want to know about a headache?
- Any warnings
- Location
- Severity
- Duration
- Frequency
What do you examine in a child presenting with headache?
- Growth parameters, OFC and BP
- Sinuses, teeth and visual acuity
- Fundoscopy
- Visual fields
- Cranial bruit
- Focal neurological signs
- Cognitive and emotional status
Which features would suggest a childhood migraine?
- 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
Which features suggest a tension headache?
- Diffuse and symmetrical headache
- Band like distribution
- Present most of the time
- Constant ache
Which features of a headache suggest a raised intracranial pressure?
- Aggravated by coughing, bending, straining at stool etc.
- Woken from sleep with headache +/-vomiting
Which features of a headache suggest an analgesic overuse headache?
- Headache is back before another dose is allowed
- Paracetamol/NSAIDs
- Problem with compound analgesics e.g. cocodamol
What are the indications for neuroimaging in a child presenting with a headache?
- 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
How can migraines be managed in children?
- Acute: effective pain relief and triptans
- Preventative: pizotifen, propranolol, amitryptiline, topiramate and valproate
How can TTHs be managed in children?
- Reassurance
- MDT management
- Attention to underlying problems
- Acute: simple analgesia
- Prevention: amitryptiline
- Discourage analgesics in chronic TTH
What is an epileptic seizure?
An abnormal excessive hyper synchronous discharge from a group of cortical neurons
Name some common non-epileptic seizures and other mimics in children
- 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
What is a febrile convulsion?
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
Name some common features of seizures and the type of seizure they are associated with?
- Jerk/shake: clonic, myoclonic and spasms
- Stiff: usually tonic
- Fall: atonic, tonic and myoclonic
- Vacant attack: absence and complex partial seizure
What is the mechanism of an epileptic fit?
- 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
Describe the stepwise approach to diagnosing epilepsy
- 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
How can epilepsy be diagnosed?
- History
- Video recording of the event
- ECG in convulsive seizures
- EEG
- MRI Brain
- Genetics
- Metabolic tests
How can epilepsy be managed in children?
- Generalised: valproate or levetiracetam
- Focal: carbamazepine
- Other therapies: steroids, immunoglobulins and ketogenic diet
- Vagal nerve stimulation
- Surgery
When do the fontanelles close?
- Posterior: 2-3 months after birth
- Anterior: 1-3yrs of age
What is microcephaly and what can cause it?
- OFC < 2SD
- Usually indicative of a small brain
- Antenatal, postnatal, genetic and environmental
What is macrocephaly and what else do you want to know?
- OFC > 2SD
- Suture closure, fontanelles, familial, hydrocephalus?, large brain and is development normal
- Other physical abnormalities: facial features, hepatosplenomegaly, bony deformities etc.
What is plagiocephaly?
Flat head (deformational type gives a parallelogram appearance)
What is brachycephaly?
Short head or flat at the back
What is scaphocephaly?
Boat shaped skull
What is craniosynostosis?
When the bones in a babies skull fuse too early leading to a misshapen skull
When should a neuromuscular disorder be suspected?
- 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
What are the features of duchenne muscular dystrophy?
- 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
Which features suggest a neuropathy?
- Distal weakness
- May have sensory signs
- Reflexes lost early
- Fasciculations may be present
- No contractures or myocardial dysfunction
Which features suggest a myopathy?
- Usually proximal
- Pure motor signs
- Reflexes preserved
- No fasciculations
- Contractures
- May have myocardial dysfunction
