Paediatric neurology Flashcards
What are some developmental points which are important for any paeds history?
Motor milestones Speech and language development Early cognitive development Play esp. symbolic play and social behaviour Self-help skills Vision and Hearing assessment
Which syndrome is associated with about 1% of OCD and ADHD sufferers?
Tourette
What are some clinical classifications of headaches in kids?
Isolated acute
Recurrent acute
Chronic progressive
Chronic non-progressive
What are some useful examinations in headaches?
Growth parameters Sinuses Teeth Visual acuity Fundoscopy Visual fields Cranial bruits Cognitive and emotional status
What are some signs and symptoms associated with childhood migraine?
Abdominal pain Nausea Vomiting Visual disturbance Paraesthesia Weakness Pallor Photosensitivity Fatigue Symptoms eased by dark quiet setting Family history
How does pain the differ between migraine and tension headache?
Migraine hemicranial, throbbing pain
Tension headache diffuse and symmetrical band-like distribution of pain
How does persistence of pain differ between migraine and tension headache?
Migraine relieved by rest
Tension headache present most of the time
What are some signs which point to a raised ICP causing the pain?
Aggravated by activities raising ICP like coughing, passing, stool, bending
Woken from sleep
Vomiting
What are some signs which point to analgesic overuse causing the pain?
Headache is back before allowed to use another dose
Paracetamol/ NSAIDs
Particular problem with compound analgesics eg. Cocodamol
What might indicate neuroimaging for headahce?
Cerebral dysfunction Raised ICP New focal neurological deficit eg. new squint Seizures Personality change Unexplained deterioration of school work
What are some preventative meds given at least 1 week after migraine?
Pitzotifen Propanolol Amitryptyline Topiramate Valproate
Do we use any meds for prevention in TTH?
Can use amitryptyline
How do we manage acute TTH attacks?
Simple analgesia
Why do we discourage analgesics in chronic TTH?
Often overuse is the cause
What is an epileptic seizure?
An abnormal excessive hyper synchronous discharge from a group of (cortical) neurons
What are some causes of acute symptomatic seizures?
Hypoxia-ischaemia
Hypoglycaemia
Infection
Trauma
What is a febrile convulsion?
Seizure occurring in infancy/childhood
Associated with fever but no evidence of infection
What kind of seizure would be indicated by a jerk/shake movement?
Clonic
Myoclonic
Spasms
What kind of seizure usually causes stiffness?
Tonic
What kind of seizure usually causes falls?
Atonic
Tonic
Myoclonic
What kind of seizure causes vacant attacks?
Absence
Complex partial
What is affected in decreased inhibition during an epileptic fit?
GABA
What is affected in excessive excitation during an epileptic fit?
Glutamate
Aspartate
What are the 3 chemical triggers of epileptic fits?
Decreased inhibition
Excessive excitation
Excessive influx of Na and Ca ions
What is the moa of an epileptic fit?
Summation of a multitude of electrical potentials results in depolarization of many neurons which can lead to seizures, can be recorded from surface electrodes (Electroencephalogram)
What is are some good questions for a stepwise approach to epilepsy
diagnosis?
Is the paroxysmal event epileptic in nature?
Is it epilepsy?
What seizure types are occurring?
What is the epilepsy syndrome?
What is the etiology?
What are the social and educational effects on the child?
What is EEG useful for?
Identifying seizure types
Seizure syndrome
Aetiology
What are some good tests for determining seizure aetiology?
MRI
EEG
What are the 1st line treatment options for generalised epilepsies?
Sodium valproate
Levetiracetam
Which group should not be prescribed sodium valproate?
Girls
What is an option for drug-resistant epilepsies?
Ketogenic diet
What is first line for focal epilepsies?
Carbamazepine
What are some new AEDs with fewer side effects?
Lamotrigine
Perampanel
Levatiracetam
When does the anterior fontanelle usually close?
1-3 years
What is the standard measurement of head size?
Occipitofrontal circumference
What is plagiocephaly?
Flat head
What is brachycephaly?
Short head or flat at back
What is scaphocephaly?
Boat shaped skull
When should you expect a neuromuscular (NM) disorder?
Baby ‘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 some signs of Duchenne Muscular Dystrophy?
Delayed gross motor skills Symmetrical proximal weakness Elevated creatine kinase Cardiomyopathy Resp involvement
What is a blood result to be expected in Duchenne Muscular Dystrophy?
Elevated Creatine Kinase
>1000
What are some genes associated with DMD?
Xp21
Dystrophin
How does symmetrical proximal weakness in DMD present?
Waddling gait
Calf hypertrophy
Gower’s sign positive
What is a positive Gower’s sign?
Child gets up from prone position by going onto all-fours then extending legs and arms, forming a triangle
Hands then lifted onto thighs and child “crawls” up thighs to upright position
Weakness of proximal hip muscles
What cells are affected by spinal muscular atrophy?
Anterior horn cell
