paediatric neurology - headaches Flashcards

1
Q

when does the brain acquire most of its growth

A

1st 2yrs of life

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2
Q

why is child neurology dynamic

A

brain continues to grow and brain functions evolve

neurodevelopment continues to progress

static lesion can produce evolving features

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3
Q

pathology in paediatric neurology

A

congenital anomalies

neurogenetic diseases and syndromes

neurometabolic diseases and syndromes

acquired: infection, ischaemia, trauma, tumour

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4
Q

neurological consultation in childhood

A

interactive hx taking

avoid jargon

time course of symptoms is crucial

perinatal, developmental and FHx

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5
Q

what to ask about in the developmental hx

A

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

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6
Q

neurological examination in childhood

A

opportunistic approach and observation skills

appearance

gait

head size

skin findings

real world examination - depends on age

synthesis of hx and clinical findings into DDx and investigation plan

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7
Q

how common are neurological conditions in childhood

A

10% of 1y care consultations

25% of hospitalised children

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8
Q

most common neurological conditions

A

migraine: 7.7% of children 10-17

TBI: 180-300/100 000

tourette syndrome: 1% of all children w/ high frequency in ADHD and OCD

epilepsy: 0.7% of all children, ⅓ will have intractable epilepsy

brain tumours: 2nd most common cancer in children

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9
Q

how common are headaches in children

A

40% by age 7

75% of children by age 15

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10
Q

clinical evaluation of headaches in children

A

isolated acute

recurrent acute

chronic progressive

chronic non-progressive

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11
Q

how often does a headache need to be present for it to be classed as chronic

A

at least 15 out of 30 days of the month

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12
Q

taking a headache hx

A

is there more than one type of headache

SOCRATES

for each episode: any warning, location, severity, duration, frequency

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13
Q

headache examination

A

growth parameters, OFC, BP

sinuses, teeth, visual acuity

fundoscopy

visual fields - craniopharyngioma

cranial bruit - auscultate side of head

focal neurological signs

cognitive and emotional status

  • diagnosis of headache aetiology is clinical
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14
Q

what things might indicate childhood migraine

A

hemicranial pain, throbbing, pulsatile

associated abdo pain, N+V

focal symptoms/signs before, during, after attacks: visual disturbance, paraesthesia, weakness

pallor

aggravated by bright light, noise

relation to fatigue, stress

helped by sleep, rest, dark quiet room

FHx often +ve

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15
Q

features of tension headache

A

diffuse, symmetrical

band like distribution

present most of the time (but there may be symptom free periods)

‘constant ache’

generally occur at an older age

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16
Q

what signs would point to raised ICP

A

headache aggravated by activities that raise ICP -coughing, straining at stool, bending

child is woken from sleep with headache +/- vomiting

17
Q

what signs would point to analgesic overuse headache

A

headache is back before allowed to use another dose

paracetamol/NSAIDs use

particular problem with compound analgesics e.g. cocodamol

18
Q

indications for neuroimaging

A

features of cerebellar dysfunction

features of raised ICP

new focal neurological deficit e.g. new squint

seizures, esp focal

personality change

unexplained deterioration of school work

19
Q

management of acute migraine attack

A

effective pain relief - paracetamol, ibuprofen

triptans in older children (oral/intranasal)

20
Q

preventative treatment of migraines

A

at least migraine 1/wk

pizotifen, propranolol (younger child), amitriptyline, topiramate, valproate

treatment is taken daily to prevent further episodes

21
Q

treatment for tension headaches

A

aim at reassurance - no sinister cause

MDT management

attention to underlying problems: chronic physical, psychological, emotional

acute attacks: simple analgesia

prevention: amitryptiline

discourage analgesics in chronic tension headaches - analgesia overuse is common