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Paeds Written - NEURO Flashcards

1
Q

Plagiocephaly signs O/E

A

Unilateral flat occiput

Ipsilateral ear pushed forward

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2
Q

Plagiocephaly management

A

REASURRANCE

Conservative:

  • turning cot
  • tummy time during day
  • supervised supported sitting
  • moving toys/mobiles in cot to change baby focus & head position
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3
Q

Salaam attacks - definition & what condition are they seen in?

A

Repeated flexion of heads/arms/trunk –> extension of arms
Lasts 1-2 seconds
Repeated up to 50X

Seen in West’s syndrome (Infantile Spasms)

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4
Q

Key IX findings in West’s syndrome (infantile spasms)

A

EEG –> dramatic hypsarrhythmia

CT –> diffuse or localised brain disease e.g. tuberous sclerosis

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5
Q

Most common cause of cerebral palsy?

A

Antenatal (80%) - cerebral malformation, congenital infection

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6
Q

Most common form of Cerebral palsy? Key clinical signs/sx?

A

Spastic (70%)

3 forms:

  • Hemiplegia
  • Diplegia
  • Quadriplegia

Increased muscle tone
Abnormal gait

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7
Q

Area of damage in Spastic cerebral palsy?

A

Upper motor neurons in periventricular white matter

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8
Q

Area of damage in dyskinetic cerebral palsy?

A

Basal ganglia & substantia nigra

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9
Q

Key Signs & Sx of dyskinetic cerebral palsy?

A

Athetoid movements - slow, writhing motions of hands/feet
Oro-motor issues
Difficulty holding objects (fluctuating muscle tone)

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10
Q

Key Signs & Sx of ataxic cerebral palsy?

A

Cerebellar signs

  • Nystagmus
  • Ataxia
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11
Q

Medications for spasticity in cerebral palsy

A

Oral diazepam
Oral & intrathecal baclofen
Botulinum toxin Type A

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12
Q

What monitoring is required whilst taking Ritalin (Methylphenidate)?

A

Height & weight every 6 months

ECG before starting tx

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13
Q

Management of ADHD

A

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
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14
Q

SE of Ritalin (methylphenidate)

A

Abdo pain
Nausea
Dyspepsia

Effect on growth

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15
Q

IHS Criteria for Paediatric migraine without aura

A

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
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16
Q

Medication options for Paediatric migraine

A

Ibuprofen > Paracetamol

Triptans

  • over 12 yrs
  • sumatriptan nasal spray licensed (taste = poor tolerance)
  • NOT oral

Prophylaxis

  • unclear evidence
  • GOSH 1st line = pizotifen + propranolol
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17
Q

IHS criteria for Paediatric tension headache

A

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)
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18
Q

Abx for Paediatric meningitis

A

<3 months = Cefotaxime + amoxicillin/ampicillin

> 3 months = Cefotaxime/Ceftriaxone
+/- IM benzylpenicillin ASAP (in community?)

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19
Q

Criteria for giving Dexamethasone in meningitis

A

Over 3 months (or > 1 month and H. influenzae)

Frankly purulent CSF
Bacteria on gram stain
WBC >1000/uL
Raised WCC + protein >1g/L

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20
Q

Purpura fulminans - what is it? complication of what?

A

Seen in meningitis

Haemorrhagic skin necrosis from DIC
Acute
Blood spots/bruising of skin
Can be fatal

Tx = FFP, debridement, amputation

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21
Q

Contraindications to an LP

A 
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

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22
Q

Benign rolandic epilepsy key signs/Sx

A

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

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23
Q

Juvenile myoclonic epilepsy key Signs/Sx

A

12-19 year olds
affect neck, shoulders, upper arms
Most occur after waking

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24
Q

What anti-seizure medication should be avoided in myoclonic seizures

A

Lamotrigine - makes seizures worse

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25
What anti-seizure medication should be avoided in absence seizures
Carbamazepine - makes seizures worse
26
Tonic-clonic seizure meds
Sodium valproate Lamotrigine, Carbamazepine, Oxcarbazepine
27
Absence seizure meds
Sodium valproate, Ethosuximide Lamotrigine
28
Myoclonic seizure meds
Sodium valproate Levetiracetam, topiramate
29
Focal seizure meds
Carbamazepine, lamotrigine Leviteracetam, oxcarbazepine, sodium valproate
30
Sodium valproate key side effects
Hair loss (transient) Weight gain Liver failure - rare
31
Carbamazepine key side effects
``` Rash Neutropenia Hyponatraemia (SIADH) Enzyme inducer - careful with COCP! Ataxia ```
32
Lamotrigine key side effects
Stevens-Johnson syndrome
33
Status Epilepticus Tx pathway
1. Airway + high flow O2 + check BM 2. 5 mins convulsing: - if existing vascular access (or can be established quickly) = IV or IO Lorazepam 0.1mg/kg - if not = buccal midazolam 0.5mg/kg OR rectal diazepam 0.5mgkg 3. Call for senior help + Lorazepam 0.1mg/kg IV or IO - prepare phenytoin - re-confirm epileptic seizure 4. Senior help should be present - ICU / anaesthetist advice - consider retcal paraldehyde - give phenytoin 20mg/kg IV or IO over 20 mins NOTE: if already on phenytoin, give phenobarbitone (same dose) at 5 mins 5. still seizing --> rapid sequence induction, intubation + ventilation - done by anaesthetist
34
Myelomeningocele clinical features
Variable neuro deficit Small defect: - mobility issues - intellectual impairment - bladder dysfunction Large defect: - loss of lower lim function - anaesthesia - urinary / faecal incontinence
35
Key Examination finding in Spina Bifida Occulta
Cutaneous markers over side of failed vertebral fusion - hair tuft - port wine stain - sinus
36
Indications for CT scan of head (within 1 hour)
Head injury + two or more of: - LOC > 5mins - Abnormal drowsiness - 3+ discrete episodes of vomiting - dangerous mechanism/high impact - amnesia >5 mins (anterograde or retrograde) OR one or more of: - non accidental injury - post-traumatic seizure - GCS <14 or 2 hours after injury GCS < 15 - suspected open/depressed skull fracture - tense fontanelle - basal skull fracture signs - focal neuro deficit - child <1 year and bruise, swelling or laceration >5cm on head
37
Basal skull fracture signs
Raccoon eyes Battle sign - bruising over mastoid Rhinorrhoea, otorrhoea
38
Extradural haemorrhage clinical features
Lucid interval THEN deteriorating concsiousness +/- seizures +/- focal neuro signs - dilatation of ipsilateral pupil, contralateral limb paresis
39
Subdural haemorrhage clinical features
Gradually decreasing GCS No lucid interval Forms part of 'shaken baby' tirad with - retinal haemorrhages - encephalopathy
40
Subarachnoid haemorrhage clinical features
Acute onset head pain neck stiffness fever +/- seizures or coma (May have Hx of known aneurysm or AVM)
41
Grading of intraventricular haemorrhage
Grade I = germinal matrix only Grade II = intraventricular but no enlargement Grade III = intraventricular + enlargement Grade IV = into surrounding brain tissue
42
Complications of intraventricular haemorrhage
Grade 3/4 --> long term brain injury Blood clots within ventricles --> hydrocephalus Periventricular white matter damage (periventricular leukomalacia) --> spastic cerebral palsy
43
Causes of communicating hydrocephalus
Meningitis - pneumococcal, TB | Subarachnoid haemorrhage
44
Signs & Sx of hydrocephalus
``` Increased head circumference Tense fontanelle Papilloedema Ataxic gait 6th CN palsy Sunset sign - eyes driven down bilaterally ```
45
Medical & surgical options for hydrocephalus
Surgical: Ventriculo-peritoneal shunt - may need replacing if becomes blocked/infection Endoscopic tx - creates ventriculostomy Medical: Furosemide - inhibit CSF production
46
Types of Tic
Motor Vocal Phonic
47
Prognosis of Tic disorder
1 in 3 rule: 1 in 3 have no tic as adult 1 in 3 - mild 1 in 3 - severe
48
Non-medical strategies for treating Tic disorder
Self help - sleep & stress management - encourage parents NOT to draw attention or punish tic Habit reversal therapy - teach another movement to 'compete' with tic Exposure & response prevention - help child adjust to unpleasant sensation experienced before a tic
49
Medical Tx of Tic disorder
1st line = antipsychotic e.g. risperidone 2nd line * clonidine - treat ADHD at same time * Clonazepam * tetrabenazine - only for tics with underlying condition e.g. Huntington's * Botilunum toxin - lasts <3 months
50
Criteria to diagnose Neurofibromatosis Type 1
Need 2+ of the following: 6+ cafe au last spots (>5mm pre-puberty, >15mm post-puberty) >1 neurofibroma Axillary freckling Optic glioma +/- visual impairment 1 Lisch nodules (haemartoma on iris) - seen on slit lamp examination Bony lesions from spheroid dysplasia +/- eye protrusion Affected 1st degree relative
51
Inheritance of Neurofibromatosis Type 1
Autosomal dominant High penetrance variable expression
52
Cutaneous features of Tuberous Sclerosis
Woods Lamp (medical LED) --> 'Ash leaf' /Fitzpatrick patch / amelanocytic naevi Shagreen patches - rough skin on lumbar spine Angiofibromata - butterfly facial distribution
53
Neuro features of Tuberous sclerosis
Infantile spasms / West's syndrome - seizures - progressive developmental delay Focal epilepsy Intellectual disability (often with ASD) Non-communicating hydrocephalus (from subependymal giant cell astrocytoma)
54
Ix & results in Tuberous sclerosis
CT --> calcified subependymal nodules, tubers - seen from 2 years + NOTE: MRI is more sensitive
55
Key clinical features of Sturge-Weber syndrome
Port wine stain in region of trigeminal nerve ``` Epilepsy Intellectual disability Contralateral hemiplegia Glaucoma Phaeochromocytoma ```
56
Most common forms of somatisation in children
Recurrent abdo pain - peaks 9yo, sharp, colicky Recurrent headaches - peak 12yo Limb pain, aching muscles, fatigue, other neuro Sx - peaks >12 yo
57
Most common Paediatric CNS tumour
Pilocytic astrocytoma (WHO grade I)
58
Subtentorial tumour signs/sx
Cerebellar ataxia Long tract signs - increased tone, brisk reflexes, clonus CN palsies
59
Supratentorial CNS tumour signs/sx
Focal neuro deficit Seizures Personality change
60
Best imaging for CNS tumours
MRI > CT / PET
61
CNS tumour management - general principles
Surgery = 1st line - resect as much as possible - minimise damage to normal tissue Radiotherapy - for low & high grade gliomas, mets Chemotherapy (incl biological agents) - for high grade gliomas

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