Paeds NEURO Flashcards
What is a reflex anoxic seizure?
Episodes of tonic clonic fitting due to cardiac asystole secondary to vagal inhibition
What are the causes of reflex anoxic seizure?
Can be triggered by pain, head trauma, cold food (ice cream), fright, fever
What is a febrile convulsion?
A seizure and fever in the absence of intracranial infection
What is the age group that can be affected by febrile convulsions?
6m to 3y
What are the signs and symptoms of febrile convulsions?
Generalised tonic clonic seizure on background of fever
What is the difference between a simple and complex febrile seizure?
Simple: do not cause brain damage and no increased risk of epilepsy
Complex: focal, <15 mins, repeated in same illness, increased risk of subsequent epilepsy
What investigations should be done following a febrile seizure?
Identify and manage the cause of fever
No other main investigations (don’t do an EEG)
May potentially want to screen for meningitis/ encephalitis, do a urine MC+S and blood glucose
How should febrile convulsion be managed during the seizure?
Protect from injury and do not restrain
If seizure lasts <5 minutes do nothing
If seizure lasts >5 mins and no drugs are available, call an ambulance
If drugs are available: after 5 mins administer PR diazepam OR buccal midazolam
When should an ambulance be called for febrile convulsion?
1st seizure - of any duration or cause
Seizure lasts >5 mins with no drugs
Breathing difficuties
Which children should be admitted to hospital following a febrile convulsion?
First febrile seizure<18 months old
Diagnostic uncertainty about the cause
Complex febrile seizure
Currently on Abx
What system is used to classify seizures?
International League Against Epilepsy 2017
What is the correct name for an absence seizure these days?
Generalised non-motor seizure
What is the difference in symptoms between tonic-clonic and myoclonic?
Tonic clonic is the big one with violent muscle contractions, eyes rollingback, tongue biting, incontinence and both aura and post-ictal phenomena
Myoclonic = brief arrhythmic muscular jerking movement
What is the most common form of childhood epilepsy?
Benign Rolandic Epilepsy - myoclonic seizures in a 3-12 year old
What are the 3 different types of myoclonic epilepsy
Benign rolandic (3-12y)
Juvenile myoclonic epilepsy (12-18y)
Progressive myoclonic epilepsy
What is the other name for benign rolandic seizures?
Sylvian seizures
What are the signs and symptoms of benign rolandic epilepsy?
Myoclonic seizures during sleep involving face and UL with hypersalivation
What are the signs and symptoms of juvenile myoclonic epilepsy?
Myoclonic seizures involving upper body just after waking up and beginning after puberty
What is progressive myoclonic epilepsy?
Rare syndromes of combination of myoclonc and tonic-clonic seizures, with patient deteriorating over time
For what type of epilepsy is treatment not usually given?
Benign Rolandic Epilepsy
What type of antiepileptic actually exacerbates myoclonic seizures?
Lamotrigine
What type of antiepileptic actually exacerbates absence seizures?
Carbamazapine
What is the 1st line for rescue therapy for prolonged epileptic seizures?
Buccal midazolam
Which antiepleptic drug requires monitoring?
Carbamazapine
After how long seizure-free can antiepileptic therapy be stopped?
2 years
Recall 2 Side effects of valporate
Weight gain, hair loss
How is status epilepticus defined?
1 seizure lasting >5 mins OR
>2 seizures within a 5 min period without the person returning to normal between them 1 febrile seizures lasting >30 mins
What is the age range of peak incidence for infantile spasm?
3-8 months
What is an infantile spasm?
Sudden, rapid, tonic contraction of trunk and limb muscles with gradual relaxation over 0.5-2 seconds
What is a ‘Salaam’ attack?
Head goes down and arms go up in the air
How should West Syndrome be investigated?
EEG - shows hypoarrhythmias
What is the prognosis for West syndrome?
Poor
How should West syndrome be managed?
Vigabatrin or corticosteroids
What investigations should be done for vasovagal syncope?
Lying and standing BP with ECG if indicated
FBC (to query anaemia/ bleeding)
What are the indications for CT head in children?
Head injury + at least 1 of:
- suspected NAI
- post-traumatic seizure
- GCS <14
- Suspected skull fracture
- Focal neurology
OR
2 other risk factors
(LOC >5 mins, abnormal drowsiness, >3 episodes of vomiting, high-impact injury, amnesia > 5 mins)
Give 2 signs of tear of the MMA
Battle sign
Racoon eyes
What are the signs and symptoms of extradural haemorrhage?
Lucid interval followed by deterioration
Potential focal neurology
How should extradural haemorrhage be managed?
Fluid resuscitation to correct hypovolaemia
Evacuation of haematoma and arrest bleeding
What is the cause of subdural haemorrhage?
Tear in vein as it crosses subdural space
What is the main symptom of subdural?
Gradually decreasing GCS
What is often the cause of subdural in infants?
NAI
Which infants are most at risk of intraventricular haemorrhage?
Premature babies due to VLBW
What are the 2 main causes of intraventricular haemorrhage in infants?
ECMO in preterm babies with ARDS
Congenital CMV infection
ECMO = extracorporeal membrane oxygenation
Recall the signs and symptoms of intraventricular haemorrhage
Sleepiness and lethargy, apnoea, reduced
Moro reflex, low tone, tense fontanelle
Which investigation is used to diagnose intraventricular haemorrhage in a baby?
Trans-fontanelle USS
How should intraventricular haemorrhage be treated in a baby?
Fluids
Anticonvulsant
Acetazolamide (to reduce CSF) and LP
Ventriculo-peritoneal shunt if hydrocephalus
What is the difference between communicating and non-communicating hydrocephalus?
Communicatig: CSF flow obstructed after it enters the ventricles
Non-communicating: flow of CSF is obstructed WITHIN the ventricles
What are the 2 causes of communicating hydrocephalus?
Meningitis
SAH
What are the possible causes of non-communicating hydrocephalus?
Aqueduct stenosis:
Congenital causes: Dandy-Walker malformation or Chiari malformation
Acquired: IVH/ tumour
What is the sunset sign?
Eyes appear to be driven down bilaterally - sign of raised ICP
What are the 2 key investigations for hydrocephalus?
Cranial USS
Measurement of head circumference
What is the first line management for hydrocephalus?
Ventriculoperitoneal shunt
What is the second line management for hydrocephalus?
Furosemide - to inhibit CSF production
What % of migraines have aura?
10%
Is migraine likely to be UL or BL?
Could be either
What are the symptoms of cluster headaches?
UL (eyes/ side of face) sharp throbbing pain, causing swelling/ watering inclusters
What are some signs that migraine is secondary to something more sinister?
Visual field defects, gait or cranial nerve abnormalities, growth failure, papilloedema, early morning headache
If simple analgesia doesn’t work, what is the 2nd line pain med in migraines?
Nasal sumatriptan
Recall 2 prophylactic medications for migraine
Topiramate
Propranolol
What is Tourette’s?
Chronic and multiple tics - starting before 18y old and persisting >1 year
What are the 3 types of tic?
Motor, vocal or phonic
Recall 2 therapies that are useful in tics
- Habit reversal therapy (learn movements to ‘compete’ with tics)
- Exposure with response prevention - help the child get used to the unpleasant feeling before a tic so that they can stop the tic occuring
What is the first line medication for tic disorder?
Antipsychotics - eg risperidone
Which form of MEN is NF1 associated with?
MEN2
Recall some signs and symptoms of NF1
Café au lait spots
Neurofibroma
Axillary freckles
Lisch nodule
What is tuberous sclerosis?
Rare genetic condition that causes mainly benign tumours to develop in different parts of the body
Recall 3 cutaneous features of tuberous sclerosis
“Ash leaf” patch
Shagreen patches (rough skin on lumbar spine)
Angiofibromata (butterfly facial distribution)
Recall some neurological features of tuberous sclerosis
Infantile spasms
Focal epilepsy
Intellectual disability (often with ASD)
Why is there a risk of hydrocephalus in tuberous sclerosis?
Development of subependymal giant cell astrocytoma
Which investigations are useful for diagnosing tuberous sclerosis?
CT/ MRI
What is the layman’s term for the haemangioma in Sturge Weber syndrome?
Port wine stain
Where does the haemangiomatous facial lesion present in Sturge Weber Syndrome?
Trigeminal nerve distribution
Recall some signs and symptoms of Sturge Weber Syndrome
Epilepsy
Contralateral hemiplegia
Phaeochromocytoma
Intellectual disability
Glaucoma
How should Sturge Weber Syndrome diagnosis be confirmed?
MRI
What are the 3 symptoms that may present via somatisation?
Abdo pain
Reucrrent headaches
Limb pain
What is Apley’s rule?
The further the pain is from the umbilicus, the more likely the pain is of an organic nature
What is the 1st line management for somatisation?
Promote communication between family and children
Pain-coping skills ie relaxation techniques for headaches
What should be done if 1st line treatments for somatisation fail?
Referral to CAMHS
Which type of developmental delay has the best prognosis?
Isolated delay (global has association with syndromes that have poorer prognosis)
Which is more common in children out of hypermetropia and myopia?
Hypermetropia
What is the cause of Retinopathy of Prematurity?
Vascular proliferation leads to retinal detachment –> fibrosis and blindness
What is the main RF for retinopathy of prematurity?
Uncontrolled use of high concentrations of oxygen
What are the 2 key signs of retinopathy of prematurity?
Unusual eye movements
White pupils
What is the first line treatment of retinopathy of prematurity?
Laser photocoagulation
What is strabismus?
Abnormal alignment of eyes
At what age is strabismus diagnosed?
1-4 years
What are the 2 types of strabismus?
Non-paralytic (refractive error in one or more eyes)
Paralytic (squinting eye could be caused by motor nerve paralysis or SOL - 3rd nerve palsy)
How should strabismus be managed?
1st line = glasses
2nd line = eye patching
3rd line = eye drops
4th line = eye muscle surgery
Which burn pattern is typical of NAI?
Glove and stocking
Which type of long bone fracture is indicative of NAI?
Spiral fractures
What is the classic triad of features in shaken-baby syndrome?
- Retinal haemorrhages
- CT showing brain swelling/ encephalopathy
- CT showing subdural haematoma
What needs to be ruled out in suspected NAI?
Leukaemia, ITP and haemophilia
What is the definition of SIDS?
Deaths which remain unexplained after a post-mortem
What is the peak age for SIDS?
2-4 months
Recall some important risk factors for SIDS
Front-sleeping baby
Prematurity, LBW, male, maternal smoking, microenvironment (pillow, heat)
For how long should parents share a room with baby?
6 months
Which organisation provides support for SIDS?
Lullaby Trust
When do fontanelle close by?
1 year usually, can be as late as 2
What should be given before buccal midazolam in a fitting child?
Oxygen
Why shouldn’t metoclopramide be given to children?
Can give oculogyric crises
Recall the 5 points of the Fraser guidelines
- YP understands professional’s advice
- YP cannot be persuaded to inform parents
- YP is likely to begin/ continue having sex regardless of contraception
- Physical/ mental wellbeing likely to suffer from lack of contraception
- YP’s BI require them
What % of children who have a febrile convulsion will have one again?
33-50%
Does the absence of papilloedema on fundoscopy exclude a diagnosis of raised ICP?
No - papilloedema may take between hours and weeks to develop
At what point in a fever/illness will febrile convulsions normally occur?
Typically quite early on in the rise in fever
What is the typical duration of febrile convulsions?
Less than 15 minutes - a prolonged seizure would raise suspicion of a more serious infection
What is a common cause of febrile convulsions?
Roseola (HHV6)
Often minor viral infections such as:
Otitis media
Tonsilitis
UTI
