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Paediatrics > Paediatric Neurology > Flashcards

Paediatric Neurology Flashcards

1
Q

What should be asked about when assessing a developmental history in paediatric neurology?

A 
Motor milestones
Speech and language development
Early cognitive development
Play- especially social and symbolic play
Self-help skills
Vision and hearing assessment
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2
Q

How is neurological examination done in children?

A 
Opportunistic approach and observation skills
Appearance
Gait
Head size
Skin findings
Real word examination- dependent on age
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3
Q

What are the common patterns of headache in children?

A

Isolated acute
Recurrent acute
Chronic progressive
Chronic non-progressive

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4
Q

How is a child with headache examined?

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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5
Q

What are the signs of childhood migraine?

A

Associated abdominal pain, nausea or vomiting
Focal symptoms or signs before, during or after attack (visual disturbance, paraesthesia, weakness)
Pallor
Aggravated by bright light/noise
Related to fatigue or stress
Helped by sleep, rest or a dark room
Family history often positive

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6
Q

What are the characteristics of childhood migraine?

A 
Hemicranial pain
Throbbing/pulsatile
Abdominal pain, nausea or vomiting
Relieved by rest
Photophobia or phonophobia
Visual, sensory, motor or aura changes
Positive family history
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7
Q

What are the characteristics of tension type headache in children?

A

Diffuse
Symmetrical
Band-like distribution
Present most of the time

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8
Q

How is childhood migraine managed?

A 
Acute attack- triptans
Preventative, at least weekly:
-Pizotifen
-Propanrolol
-Amitriptyline
-Topiramate
-Valproate
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9
Q

How are tension type headaches managed in children?

A 
Aim at reassurance- no sinister cause
MDT
Attention to underlying psychological, emotional or physical problems
Acute attacks- simple analgesia
Discourage analgesics in chronic TTH
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10
Q

What are the suggestive features of raised intracranial pressure?

A

Aggravated by activities that raise ICP (coughing, straining at stool, bending)
Woken from sleep with headache +/- vomiting

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11
Q

What are the indications for neuroimaging in children?

A 
Features of cerebellar dysfunction
Features of raised intracranial pressure
New focal neurological deficit
Seizures, especially focal
Personality change
Unexplained deterioration of schoolwork
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12
Q

What is an epileptic seizure?

A

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

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13
Q

How is epilepsy defined?

A

A tendency to recurrent, unprovoked epileptic seizures

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14
Q

What conditions often mimic epilepsy in children?

A

Acute symptomatic seizures
Reflex anoxic seizures (common in toddlers)
Syncope
Parasomnias
Behavioural stereotypies
Psychogenic non-epileptic seizures (PNES)

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15
Q

What is a febrile convulsion?

A

The commonest acute symptomatic seizure in children
Most common between 3 months and 5 years of age
Associated with fever but there is no evidence of intracranial infection or defined cause for the seizure

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16
Q

How are epileptic fits triggered chemically?

A 
Decreased inhibition (GABA)
Excessive excitation (glutamate and aspartate)
Excessive influx of Na and Ca ions
17
Q

What are the main differences in child epilepsies to adult?

A

Majority are idiopathic
Majority are generalised
Seizures can be subtle (absences, myoclonus, drop attacks)
Diagnosis can be challenging due to increased incidence of non-epileptic paroxysmal disorders in children

18
Q

How are EEGs helpful in epilepsy?

A

EEGs are useful in identifying seizure types, seizure syndromes and aetiologies but are not very sensitive for diagnosis of epilepsy

19
Q

How is epilepsy diagnosed?

A

History
Video recording of event
ECG in convulsive seizures
Interictal/ ictal EEG
MRI Brain: to determine etiology eg. Brain malformations/ brain damage
Genetics: idiopathic epilepsies are mostly familial; also single gene disorders eg. Tuberous sclerosis
Metabolic tests: esp if associated with developmental delay/ regression

20
Q

How is epilepsy treated?

A

Sodium valproate (boys only) or levetiracetam- first line treatments for generalised epilepsies
Carbamazepine- first line for focal epilepsies
Other therapies- steroids, immunoglobulins, ketotic diet
Vagus nerve stimulation
Epilepsy surgery

21
Q

When do the fontanelles close?

A

Posterior fontanelle closes at 2-3 months

Anterior fontanelle closes between 1-3 years

22
Q

What are the possible head size problems in paediatrics?

A

Macrocephaly

Microcephaly

23
Q

How is microcephaly defined?

A

Occipito-frontal circumference <2 SD- mild microcephaly

OFC <3 SD- moderate/severe microcephaly

24
Q

What is the main complication of microcephaly?

A

Micranenecephaly- small brain

25
Q

How is postnatal outcome assessed in microcephaly?

A

Look at if OFC is crossing centiles or not

26
Q

How is macrocephaly defined?

A

OFC >2 SDs above the mean

27
Q

What are the causes of macrocephaly?

A

Sutural/fontanelle dysfunction
Familial
Hydrocephalus
Large brain

28
Q

When do head shape problems onset?

A

In the first year of lfie

29
Q

What are the possible head shape problems?

A

Plagiocephaly- flat head
Brachycephaly- short head or flat at back
Scaphocephaly- boat shaped skull
Craniosynostosis- bones join together too early and skull becomes malformed

30
Q

When should a neuromuscular disorder be considered?

A 
If any of the following are present:
•Baby floppy from birth
•Slips from hands
•Paucity of limb movement
•Alert but less motor activity
•Delayed motor milestones
•Able to walk but frequent falls
31
Q

What are the features of Duchenne muscular dystrophy?

A 
X-linked condition affecting 1/3500 male infants. It is associated with the following:
•Delayed gross motor skills
•Symmetrical proximal weakness
•Elevated creatinine kinase levels
•Cardiomyopathy
•Respiratory involvement in teens

Paediatrics (22 decks)

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