Paediatric Neurology Flashcards
What are some neurological pathologies seen in children?
Congenital anomalies
Neurogenetic diseases and syndromes
Neurometabolic diseases and syndromes
Acquired : Infection, Ischaemia, Trauma, Tumour
What are the aspects of a developmental history?
Motor milestones: gross and fine motor skills
Speech and language development
Early cognitive development
Play esp. symbolic play and social behaviour
Self-help skills
Vision and Hearing assessment
What are the aspects of a neurological examination in childhood?
Opportunistic approach and observation skills
Appearance
Gait
Head size
Skin findings
Real world examination (depends on age)
Synthesis of history and clinical findings into a differential diagnosis and investigation plan
How common are brain tumours in children?
Second most common cancer
What are the clinical categories for headaches?
Isolated acute
Recurrent acute
Chronic progressive
Chronic non-progressive
What should you ask when taking a headache history?
Is there more than 1 type of headache? Any warning? Location? Severity? Duration? Frequency?
What are the methods used when examining headaches?
Growth parameters, OFC, BP Sinuses, teeth, visual acuity Fundoscopy Visual fields (craniopharyngioma) Cranial bruit Focal neurological signs Cognitive and emotional status
The diagnosis of headache etiology is clinical
What are the signs of childhood migraine?
Associated abdominal pain, nausea, vomiting
Focal symptoms/signs before, during, after attack: Visual disturbance, paresthesia, weakness
‘Pallor’
Aggravated by bright light/noise
Relation to fatigue/stress
Helped by sleep/rest/dark, quiet room
Family history often positive
What are the main differences between migraines and tension headaches?
Migraine: Hemicranial pain Throbbing Abdo pain, nausea, vomiting Relieved by rest Photophobia/ phonophobia Visual, sensory, motor aura Positive family history
Tension: Diffuse, symmetrical Band-like distribution Present most of the time (but there may be symptom free periods) “Constant ache”
What are the signs of raised ICP?
Aggravated by activities that raise ICP eg. Coughing, straining at stool, bending
Woken from sleep with headache +/- vomiting
What are the signs of analgesic overuse headache?
Headache is back before allowed to use another dose
Paracetamol/NSAIDs
Particular problem with compound analgesics eg. Cocodamol
What are some indications for neuroimaging?
Features of cerebellar dysfunction Features of raised intracranial pressure New focal neurological deficit eg. new squint Seizures, esp focal Personality change Unexplained deterioration of school work
How are migraines managed?
Acute attack: effective pain relief, TRIPTANS
Preventative (at least 1/week): Pizotifen, Propranolol, Amitryptyline (TCA), Topiramate, Valproate
How are tension-type headaches managed?
Aim at reassurance: no sinister cause
Multidisciplinary management
Attention to underlying chronic physical, psychological or emotional problems
Acute attacks: simple analgesia
Prevention: Amitryptiline (TCA)
Discourage analgesics in chronic TTH
