Paeds Neuro Flashcards
4 types Cerebral palsy
1) Spastic
2) Athetoid
3) Ataxic
4) mixed
3x3 causes of cerebral palsy
Antenatal
- Chorioamnionitis
- Prematurity
- Congenital malformation
Perinatal
- Sepsis
- Chorioamnionitis
Postnatal
- Meningitis
- Trauma
- Kernicterus
Management of spasticity in cerebral palsy
Baclofen - Unknown!
Criteria for febrile convulsion
- Ax temp >37.8
- Child between 6 months & 5 years
Emergency management of febrile seizure
1) A-E
2) Check BM
3) If >5 minutes seizing give rectal diazepam (500mcg/kg)
4) If meningococcal disease suspected benzylpenicillin
3 factors indicating complex febrile seizure
1) Focal features at onset or during the seizure.
2) Duration of more than 15 minutes.
3) Recurrence within the same febrile illness.
In what proportion of children do febrile seizures recur?
30%
What advice to give parents?
- tepid sponging + call if fever at home
- call 999 if >5 mins long
Neonatal cause of meningitis
GBS, e.coli
1 month to 6 years cause of meningitis
Neisseria meningitides
Strep pneumonia
Haemophilus influenza
> 6 years meningitis
Neisseria meningitides
Strep pneumonia
> 60 years meningitis
Strep pneumonia
Investigations in child with meningitis
B: FBC, Blood cultures, U&Es, ESR, coagulation
O: Urine analysis, Urine microscopy and culture, lumbar puncture
X:
Contraindications to LP in children
- Bulging fontanelle
- Papilloedema
- Coagulation disorder (DIC)
- Rapid onset meningococcal disease (rash/fever)
- Focal neurology
Management meningitis in children
- Antibiotics
< 3 months: IV amoxicillin + IV cefotaxime
> 3 months: IV cefotaxime - Steroids
if > 1 month and Haemophilus influenzae then give dexamethasone - Fluids
treat any shock, e.g. with colloid - Cerebral monitoring
mechanical ventilation if respiratory impairment - Public health notification and antibiotic prophylaxis of contacts
ciprofloxacin is now preferred over rifampicin
ddx for riggers
Biliary sepsis (part of Charcot’s triad)
Pyelonephritis.
Visceral abscess (including lung, liver and paracolic).
Malaria.
Inv for DMD
- CK
- Muscle biopsy
- Genetic studies
Management for DMD
- Support in walking
- Corticosteroids
- cardiac & respiratory surveillance
Temporal lobe epilepsy symptoms
Hallucinations (auditory/gustatory/olfactory), Epigastric rising/Emotional, Automatisms (lip smacking/grabbing), Deja vu/Dysphasia post-ictal)
Cardiac complications of Duchenne’s muscular dystrophy
Dilated cardiomyopathy
DMD vs BMD
BMD has ABNORMAL dystrophin
DMD has absence of dystrophin
Outline the floppy infant
PARALYTIC
- Cerebral palsy
- Down’s syndrome
Non-paralytic Muscular - DMD NMJ - Myasthenia Gravis Peripheral nerve - Guillan Barre Anterior horn - Poliomyelitis
What is SMA?
Genetic condition causing death of alpha neutrons from spinal cord to NMJ
Symptoms of spinal muscular atrophy
Hyporeflexia
Fasciulation
Muscle weakness
Investigation of SMA
CK
Genetic testing
EMG
Muscle biopsy
Inheritance of SMA
Autosomal recessive
Name two types of ataxia
FRiedRiCHS Ataxia
Ataxia telangiectasia
Outline path of Friedrich’s Ataxia
F- falls R - recessive ie D - Dorsal Column involvement Recessive H - Hypertrophic Cardiomyopathy I C - Cerebellar S - Scoliosis
Three useful facts about ataxia telangiectasia
1) Presents earlier the friedirch’s ataxia
2) telangiectasia
3) associated with lymphoma
4) associated with IgA deficiency
What is an ataxia?
Cerebellar hemisphere lesion
Causes of hydrocephalus
Non-communicating - congenital
- Arnold chiari malformation
non-communicating - acquired
- Cerebral aqueduct stenosis
Communicating
- Meningeal thickening (meningitis)
Management of hydrocephalus
Pharmacological
- acetalazomide
Surgical
- ventricular-peritoneal shunt
Where does IVH arise from in pre-term infants vs term infants?
Pre-term infants
- germinal matrix
Term infants
- Choroid plexus
Three types of spina bifida
spina bifida occulta
Spina bifida cystic
- myelomeningocele - associated with areflexia & flaccid paralysis
- Meningocoele
How to prevent spina bifida?
Folic acid admin
Macroencephaly causes
- normal variation or familial trait
- disproportionate growth in chronic conditions, for example achondroplasia, sickle cell anaemia, rickets, failure to thrive
- hydrocephalus
Microencephaly causes
Chromosomal - Patau's syndrome Toxins - FAS Virus - Cytomegalovirus, Zika virus
Most common cause brain tumour in children
Glioma (astrocytoma)
Brain tumour presentation
Headache + red flag
Define chronic fatigue syndrome
6 months fatigue +
Headache of new type, pattern, or severity.
Multi-joint pain without swelling or erythema.
Muscle pain.
Post-exertional malaise for longer than 24 hours.
Significant impairment in short-term memory or concentration.
Sore throat.
Tender lymph nodes.
Unrefreshing sleep.
Name four head sutures
Metopic
Coronal
Saggital
Lamboid
