paediatric neurology - headaches Flashcards
when does the brain acquire most of its growth
1st 2yrs of life
why is child neurology dynamic
brain continues to grow and brain functions evolve
neurodevelopment continues to progress
static lesion can produce evolving features
pathology in paediatric neurology
congenital anomalies
neurogenetic diseases and syndromes
neurometabolic diseases and syndromes
acquired: infection, ischaemia, trauma, tumour
neurological consultation in childhood
interactive hx taking
avoid jargon
time course of symptoms is crucial
perinatal, developmental and FHx
what to ask about in the developmental hx
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
neurological examination in childhood
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
how common are neurological conditions in childhood
10% of 1y care consultations
25% of hospitalised children
most common neurological conditions
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
how common are headaches in children
40% by age 7
75% of children by age 15
clinical evaluation of headaches in children
isolated acute
recurrent acute
chronic progressive
chronic non-progressive
how often does a headache need to be present for it to be classed as chronic
at least 15 out of 30 days of the month
taking a headache hx
is there more than one type of headache
SOCRATES
for each episode: any warning, location, severity, duration, frequency
headache examination
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
what things might indicate childhood migraine
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
features of tension headache
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
