Paediatric Neurology Flashcards
What should be asked about when assessing a developmental history in paediatric neurology?
Motor milestones Speech and language development Early cognitive development Play- especially social and symbolic play Self-help skills Vision and hearing assessment
How is neurological examination done in children?
Opportunistic approach and observation skills Appearance Gait Head size Skin findings Real word examination- dependent on age
What are the common patterns of headache in children?
Isolated acute
Recurrent acute
Chronic progressive
Chronic non-progressive
How is a child with headache examined?
Growth parameters, OFC, BP Sinuses, teeth, visual acuity Fundoscopy Visual fields (craniopharyngioma) Cranial bruit Focal neurological signs Cognitive and emotional status
What are the signs of childhood migraine?
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
What are the characteristics of childhood migraine?
Hemicranial pain Throbbing/pulsatile Abdominal pain, nausea or vomiting Relieved by rest Photophobia or phonophobia Visual, sensory, motor or aura changes Positive family history
What are the characteristics of tension type headache in children?
Diffuse
Symmetrical
Band-like distribution
Present most of the time
How is childhood migraine managed?
Acute attack- triptans Preventative, at least weekly: -Pizotifen -Propanrolol -Amitriptyline -Topiramate -Valproate
How are tension type headaches managed in children?
Aim at reassurance- no sinister cause MDT Attention to underlying psychological, emotional or physical problems Acute attacks- simple analgesia Discourage analgesics in chronic TTH
What are the suggestive features of raised intracranial pressure?
Aggravated by activities that raise ICP (coughing, straining at stool, bending)
Woken from sleep with headache +/- vomiting
What are the indications for neuroimaging in children?
Features of cerebellar dysfunction Features of raised intracranial pressure New focal neurological deficit Seizures, especially focal Personality change Unexplained deterioration of schoolwork
What is an epileptic seizure?
An abnormal excessive hyper-synchronous discharge from a group of neurons
How is epilepsy defined?
A tendency to recurrent, unprovoked epileptic seizures
What conditions often mimic epilepsy in children?
Acute symptomatic seizures
Reflex anoxic seizures (common in toddlers)
Syncope
Parasomnias
Behavioural stereotypies
Psychogenic non-epileptic seizures (PNES)
What is a febrile convulsion?
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
How are epileptic fits triggered chemically?
Decreased inhibition (GABA) Excessive excitation (glutamate and aspartate) Excessive influx of Na and Ca ions
What are the main differences in child epilepsies to adult?
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
How are EEGs helpful in epilepsy?
EEGs are useful in identifying seizure types, seizure syndromes and aetiologies but are not very sensitive for diagnosis of epilepsy
How is epilepsy diagnosed?
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
How is epilepsy treated?
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
When do the fontanelles close?
Posterior fontanelle closes at 2-3 months
Anterior fontanelle closes between 1-3 years
What are the possible head size problems in paediatrics?
Macrocephaly
Microcephaly
How is microcephaly defined?
Occipito-frontal circumference <2 SD- mild microcephaly
OFC <3 SD- moderate/severe microcephaly
What is the main complication of microcephaly?
Micranenecephaly- small brain
