Paediatric Neurology Flashcards
Due to the immaturity of the childs nervous system, what can be expected to happen if the child experiences neural damage early in life?
The lesion may develop evolving characteristics as the childs develops
Develop new symptoms as they age
What are some important things to ask about in the developmental history of the child with regards to neurological conditions?
Motor milestones - gross and fine motor skills
Speech and language development
Early cognitive development
Play esp. symbolic play and social behaivour
Vision and hearing assessment
What are some of the important things to look for on examination of the child?
Head size
Skin (markers / birth marks - skin and nervous system develop closely)
Gait
Behaviour of child
What are some of the type of headache patterns that may be experienced by children?
Isolated acute
Recurrent acute
Chronic progressive
Chronic non-progressive
When is a headache considered chronic?
If the patient is suffering from it for around 15/30 days in the month
What are some important questions to ask when enquiring about a childs headache?
Is there any warning? (aura)
Location?
Severity?
Duration?
Frequency?
What is the main aim of clinical examination of a child with a headache?
To exclude secondary causes of headache and make sure it’s a primary headache
What are some important steps in the clinical examination of a child with a headache?
Sinuses / teeth / visual acuity
Fundoscopy & Visual fields (craniopharyngioma)
Head circumference (OFC) / growth / BP
Focal neurological signs
Auscultate side of head for cranial bruit
Cognitive and emotional status
What are the two major primary headache disorders in childhood?
Migraine
Tension headache
What are some signs that suggest migraine might be the cause of a childs headache?
Associated abdominal pain (esp. young children)
Sensitivity to light (photophobia)
May be precipitated by faitgue / stress
Focal symptoms beforehand: paraesthesia / weakness
Associated pallor
What are the typical characteristics of a migraine?
- Hemicranial pain
- Throbbing / pulsatile nature
- Photophobia and phonophobia
- Associated abdo pain / nausea / vomiting
- Visual / sensory aura
- Relieved by rest
What are the typical characteristics of a tension headache?
- Diffuse / symmetrical distribution
- Band like distribution
- Present most of the time (may be periods of respite)
- Described as a “constant ache”
What are some red flag signs that may indicate raised ICP in the child?
- Headache aggravated by activities that raise ICP (bending / coughing / valsalva)
- If they have ever been woken from sleep with headache +/- vomiting
What is one condition to be wary of if the patient has previously attempted to treat their headache?
Analgesic overuse headache
- Were having headaches, starting pounding back pain killers, body gets sensitized to pain killers, headaches become even worse
- Need to stop analgesia as it is only compounding the problem and try treat underlying pathology
What are some red flag signs that point towards the need for neurological imaging?
- Cerebellar dysfunction / ataxic symptoms
- Features of raised ICP
- New focal neurological deficit (eg. new squint)
- Seizures (esp. focal)
- Personality change
- Unexplained deterioration of school work
