Paeds Written - NEURO Flashcards
Plagiocephaly signs O/E
Unilateral flat occiput
Ipsilateral ear pushed forward
Plagiocephaly management
REASURRANCE
Conservative:
- turning cot
- tummy time during day
- supervised supported sitting
- moving toys/mobiles in cot to change baby focus & head position
Salaam attacks - definition & what condition are they seen in?
Repeated flexion of heads/arms/trunk –> extension of arms
Lasts 1-2 seconds
Repeated up to 50X
Seen in West’s syndrome (Infantile Spasms)
Key IX findings in West’s syndrome (infantile spasms)
EEG –> dramatic hypsarrhythmia
CT –> diffuse or localised brain disease e.g. tuberous sclerosis
Most common cause of cerebral palsy?
Antenatal (80%) - cerebral malformation, congenital infection
Most common form of Cerebral palsy? Key clinical signs/sx?
Spastic (70%)
3 forms:
- Hemiplegia
- Diplegia
- Quadriplegia
Increased muscle tone
Abnormal gait
Area of damage in Spastic cerebral palsy?
Upper motor neurons in periventricular white matter
Area of damage in dyskinetic cerebral palsy?
Basal ganglia & substantia nigra
Key Signs & Sx of dyskinetic cerebral palsy?
Athetoid movements - slow, writhing motions of hands/feet
Oro-motor issues
Difficulty holding objects (fluctuating muscle tone)
Key Signs & Sx of ataxic cerebral palsy?
Cerebellar signs
- Nystagmus
- Ataxia
Medications for spasticity in cerebral palsy
Oral diazepam
Oral & intrathecal baclofen
Botulinum toxin Type A
What monitoring is required whilst taking Ritalin (Methylphenidate)?
Height & weight every 6 months
ECG before starting tx
Management of ADHD
10 week watch + wait period
If Sx persist –> referral to specialist Paediatrician or CAMHS
1st line = behavioural therapy + educational intervention at school
- E.g. parent training programmes
2nd line = methylphenidate (Ritalin)
- only if 5 yrs +
- trial for 6 weeks
- other options if poor response OR good response but cannot tolerate SE
SE of Ritalin (methylphenidate)
Abdo pain
Nausea
Dyspepsia
Effect on growth
IHS Criteria for Paediatric migraine without aura
At least 5 episodes lasting 4-72 hours
with 2 of the following:
- affects frontal or temporal region
- triggered by strenuous activity
- pulsating
- moderate/severe intensity
and 1 of the following:
- photophobia/phonophobia
- associated nausea or vomiting
Medication options for Paediatric migraine
Ibuprofen > Paracetamol
Triptans
- over 12 yrs
- sumatriptan nasal spray licensed (taste = poor tolerance)
- NOT oral
Prophylaxis
- unclear evidence
- GOSH 1st line = pizotifen + propranolol
IHS criteria for Paediatric tension headache
At least 10 episodes lasting 30 minutes –> 7 days
with at least 2 of:
- pressing/tightening (non pulsating)
- mild/moderate intensity
- bilateral location
- no aggravation by routine physical activity
AND both of following:
- no nausea, vomiting
- no photophobia and phonophobia (or only 1)
Abx for Paediatric meningitis
<3 months = Cefotaxime + amoxicillin/ampicillin
> 3 months = Cefotaxime/Ceftriaxone
+/- IM benzylpenicillin ASAP (in community?)
Criteria for giving Dexamethasone in meningitis
Over 3 months (or > 1 month and H. influenzae)
Frankly purulent CSF
Bacteria on gram stain
WBC >1000/uL
Raised WCC + protein >1g/L
Purpura fulminans - what is it? complication of what?
Seen in meningitis
Haemorrhagic skin necrosis from DIC
Acute
Blood spots/bruising of skin
Can be fatal
Tx = FFP, debridement, amputation
Contraindications to an LP
Cardio-resp instability Focal neuro signs Signs of raised ICP - papilloedema, high BP with low HR Coagulopathy Local infection at LP site Meningococcal septicaemia
Causes undue delay in starting Abx Tx
Benign rolandic epilepsy key signs/Sx
Night time seizures
Focal/partial motor seizures, Paraesthesia
Usually 1 side of face and/or muscles of speech & swallow
Can develop into generalised tonic-clonic
Juvenile myoclonic epilepsy key Signs/Sx
12-19 year olds
affect neck, shoulders, upper arms
Most occur after waking
What anti-seizure medication should be avoided in myoclonic seizures
Lamotrigine - makes seizures worse