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Child Health > Paediatric Neurology - Head Injury, Migraines and Cerebral Palsy > Flashcards

Paediatric Neurology - Head Injury, Migraines and Cerebral Palsy Flashcards

1
Q

How can primary head injuries be split?

A

Focal

Diffuse

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2
Q

What are the causes for focal head injuries?

A

Haematoma

Contusion

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3
Q

What are the causes for diffuse head injury?

A

Diffuse axonal injury

Concussion

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4
Q

Describe the pathophysiology of a contusion

A

Microhaemorrhages and small vessel leaks lead to cerebral oedema

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5
Q

What happens in diffuse axonal injury?

A

Shearing of grey/white matter interfaces damages the axons leading to cerebral oedema

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6
Q

What happens in a concussion?

A

Axon injury means there is impaired neurotransmission, ion regulation and cerebral blood flow

This causes temporary brain dysfunction

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7
Q

When would you request an immediate CT head?

A 
LOC > 5mins
Amnesia >5mins
Drowsy
3+ episodes of vomiting
Suspect non-accidental injury
GCS <14 or <15 if <1yo
Suspicion of open or depressed skull injury
Signs of basal skull fracture
Focal neurological deficit
Bruise, swelling or laceration >5cm if <1yo
Dangerous mechanism of injury
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8
Q

Why is a CT of the cervical spine not ideal in children?

A

Ionising radiation damage the thyroid gland

Children at lower risk of C spine injuries

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9
Q

When do you CT the cervical spine in children?

A

GCS < 13
Intubation needed
Focal peripheral neurological signs
Limb paraesthesia

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10
Q

What investigation would you request for neck pain and tenderness?

A

3 view cervical spine X-Ray

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11
Q

Where can children get intracranial haemorrhages?

A 
Subdural
Extradural
Intraventricular
Subarachnoid
Lobar intracerebral
Deep intracerebral
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12
Q

What is the mechanism of a subdural haematoma?

A

Shearing force on cortical bridging veins

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13
Q

How quickly do subdural haematoma’s present?

A

Slow onset of symptoms

Chronic subdural haematoma seen in infants due to fragile bridging veins

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14
Q

How do extradural haematoma’s happen?

A

Acceleration-deceleration

Blow to side of head

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15
Q

What causes an extradural haematoma?

A

Middle meningeal artery bleed (normally)

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16
Q

Over what timeframe do extradural haematoma’s present?

A

Lucid interval first

Rapid deterioration follows

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17
Q

Who gets intraventricular haemorrhages?

A

Children with premature periventricular vasculature

Neonates

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18
Q

How do intraventricular haemorrhages appear on CT?

A

Hyperdense ventricles on CT

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19
Q

When and why do neonates get intraventricular haemorrhages?

A

Occur within 72 hours of birth

Combination of:
Delicate neonatal structures
Birth trauma
Cerebral hypoxia

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20
Q

What complications are associated with head injuries?

A

RICP
Seizures
Infection

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21
Q

What is a migraine?

A

Recurrent headache +- aura lasting 30 minutes to 48 hours

22
Q

How many migraine attacks does a child need to have before diagnosis?

A

5

23
Q

What are the types of migraines?

A

Migraine without aura (most common)

Aura without headache

Hemiplegic migraine (hemiplegia accompany/precede)

Basilar migraine (Aura followed by dizziness and syncope + minor headache)

Periodic syndromes - cyclical vomiting, abdominal migraines (often precursor to migraines)

24
Q

How do migraines present?

A

Pre-monitory symptoms of mood and appetite change

Photophobia and phonophobia common

Tiredness and depression following attack

25
Q

What are the types visual aura?

A

Fortification spectra - see picture
Micropsia - things appear smaller than they are
Macropsia - things appear larger than they are

26
Q

What other types of aura can you get?

A 
Sensory
Motor
Speech
Confusion
Brainstem dysfunction - LOC and vertigo

Visual most common

27
Q

What investigations do you do for migraines?

A

Fundoscopy
Head circumference
Neurological exam

28
Q

Describe the headache felt in migraines

A

Frontotemporal
Bilateral
Doesn’t always throb

29
Q

Who is more likely to get migraines?

A

Boys until menarche, then more common in girls

30
Q

How do very young children with migraines appear?

A

Look very ill

Abdominal pain and vomiting + being tired and wanting to sleep

31
Q

How are migraines managed?

A

Explain and reassure - parents often concerned about lack of investigations

Keep trigger diary

Avoid - lack of sleep, stress, skipped meals, video games

Sleep and food diary

Medication

32
Q

What medication is used prophylactically for migraines?

A

Propranolol
Topiramate

Prescribed by specialist in severe cases

33
Q

What medication is used to treat migraines?

A

NSAID’s, Aspirin and anti-emetic

Sumatriptan - specialist prescribed only

34
Q

What is cerebral palsy?

A

Non-progressive, permanent disorder of movement and/or posture due to damage to developing brain

35
Q

What causes cerebral palsy?

A

Damage to brain at any point upto post natal period

Hypoxic
Vascular
Teratogenic
Infection
Toxins
Trauma
Genetic
36
Q

How does cerebral palsy present?

A 
Low APGAR score
Floppy
Unusual fidgety movements 
Feeding difficulty
Delayed gross motor milestones
Speech and language delay
Toe walking
Persistent primitive reflexes
37
Q

What is the APGAR score?

A 
Appearance (skin color)
Pulse (heart rate)
Grimace response (reflexes)
Activity (muscle tone)
Respiration (breathing rate and effort)

Each scored out of 2
7+ = good health

38
Q

How is a diagnosis of cerebral palsy made?

A

Clinical diagnosis based on observation

More than one abnormality in:
Tone
Power
Reflexes
Movements
Posture
39
Q

When should you consider other diagnoses instead of cerebral palsy?

A

No risk factors
FH of progressive motor disease - SMA
Loss of acquired skill
Focal neurological sign

40
Q

How can cerebral palsy be classified?

A

Spastic - 70%
Ataxic - 10%
Dyskinetic - 10%

41
Q

What is affected in spastic Cerebral Palsy?

A

Corticospinal tract

42
Q

How does spastic Cerebral Palsy present?

A 
Increased tone
Pathological reflexes
Stiff, jerky movements
Slow slurred speech
Flexed UL
Club foot
Tiptoe gait

Hypotonia may precede spasticity

43
Q

How can you describe which limbs are affected?

A

Monoplegia
Hemiplegia - one side of body
Diplegia - either both arms or both legs
Quadriplegia

44
Q

What eventually happens in spastic Cerebral Palsy?

A

Contractors develop

Bone deformities

45
Q

What is affected in ataxic Cerebral Palsy?

A

Cerebellum

46
Q

What are the features of ataxic Cerebral Palsy?

A 
Uncoordinated muscles - movements have abnormal force and inaccuracy
Intention tremor
Poor balance
Wide gait
Delayed motor development
Early hypotonia
47
Q

What is affected in dyskinetic Cerebral Palsy?

A

Basal ganglia or Extrapyramidal pathways

48
Q

What are the features of dyskinetic Cerebral Palsy?

A 
Involuntary movements
Fluctuation in tone
Chorea - irregular unpredictable movement
Dystonia - twisting repetitive movement
Athetosis - slow writhing movement
49
Q

How is Cerebral Palsy managed?

A

MDT approach - SALT, psych, oath
Affected joints splinted
Oral diazepam and baclofen - spasticity
Botulinum injections

50
Q

What conditions are associated with Cerebral Palsy?

A 
Learning disability
Emotional and behavioural - ADHD, ASD, depression
Sensory disorder
Visual and hearing problems
Chronic constipation
Epilepsy
Incontinence

Child Health (30 decks)

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