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Paediatrics > Nervous System > Flashcards

Nervous System Flashcards

1
Q

What is cerebral palsy?

A

Abnormality of movement + posture Non-progressive Brain injuries occurring up to the age of 2

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2
Q

Causes of CP

A

Antenatally: vascular occlusion, cortical migration disorders or structural maldevelopment of brain. Genetics or congenital infection HIE during delivery 10% postnatally

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3
Q

What are preterm babies at risk of (in relation to CP)

A

Brain damage from periventricular leucomalacia (PVL) secondary to ischaemia or intravascular haemorrhage

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4
Q

Post natal causes of CP

A

Meningitis, encephalitis, head trauma, hydrocephalus, hyperbilirubinaemia

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5
Q

S+S of CP

A

Abnormal limb/ trunk posture + tone Delayed motor milestones Feeding difficulties Abormal gait Asymmetric hand function before 1 year

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6
Q

What are the types of CP?

A

Spastic Dyskinetic Ataxic

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7
Q

What are the characteristics of spastic CP?

A

Cortical pyramidal abnormality = increased muscle tone, reflexes + clonus Dynamic catch - greater resistance when muscle is stretched further Limb tone may yield in ‘clasp knife’ fashion Presents early

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8
Q

What are the types of spastic CP?

A

Hemiplegia - one arm + leg Quadriplegia - all 4 limbs Diplegia - predominantly legs

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9
Q

Levels of CP

A

1 = walks without limits 2 = walks with limitations 3 = walks using handheld mobility device 4 = self mobility with limitations 5 = transported in manual wheelchair

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10
Q

What are the characteristics of dyskinetic CP?

A

Involuntary movements Chorea = irregular + sudden Athetosis = slow writhing (fanning of fingers distally) Dystonia = simultaneous contraction of muscles giving twisting appearance Present with floppiness + delayed motor development Common cause: HIE at term

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11
Q

What are the characteristics of ataxic CP?

A

Usually genetic Early hypotonia, poor balance, delayed motor development Incoordinate movements, intention tremor, ataxic gait

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12
Q

How many children will go on to have a further febrile seizure after 1?

A

30-40%

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13
Q

When is sodium valproate used?

A

Generalised seizures

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14
Q

When is carbamazepine used?

A

Focal + tonic-clonic seizures

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15
Q

When is phenobarbitone used?

A

Newborns

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16
Q

What are infantile spasms?

A

1-6 months Infant doubles up, flexing at waist + neck + flings arms forward EEG shows disordered picture = hypsarrhthymia Caused by metabolic/ cerebral damage Commonly tuberous sclerosis

17
Q

Characteristics of tension headache

A

Symmetrical, gradual onset Described as band/ pressure Relates to stress

18
Q

Characteristics of migraines

A

Pulsatile over temporal or frontal area Accompanied by GI symptoms Can have aura Photophobia/ phonophobia

19
Q

What are the characteristics of an aura?

A

Negative phenomena eg hemianopia or scotoma Positive phenomena eg fortification spectra (seeing zigzag lines)

20
Q

What are the symptoms of raised ICP/ SOL?

A

Headache worse when lying down Morning vomiting Night time waking Change in mood + personality Visual field defects Abducens nerve affected = squint, diplopia Abnormal gait Torticollis Growth failure Papilloedema

21
Q

Rescue treatments for headaches

A

Paracetamol + NSAIDs Anti emetics = prochlorperazine + metoclopramide Serotonin agonists = sumitriptan

22
Q

Prophylactic treatments for headaches + SE

A

Pizotifen (serotonin antagonist) = weight gain + sleepiness B blockers = contraindicated in asthma Sodium channel blockers = valproate

23
Q

Complications of a head injury

A

Concussion Impaired consciousness Subdural/ extradural haematoma

24
Q

What is the first line investigation for a head injury?

A

CT head

25
Q

What are S+S of significant head injury?

A

Panda eyes CSF leak from ears/ nose Bruising over mastoid (Battle’s sign) Raised ICP - low HR, raised BP Slow pupil reactions

26
Q

What is the pathology of hydrocephalus?

A

Obstruction to outflow of CSF Dilatation of ventricular system Non-communicating = obstruction within ventricular system Communicating = at arachnoid villi (site of absorption of CSF) Accumulating CSF = enlarging head

27
Q

Causes of non-communicating hydrocephalus?

A

Congenital malformation Aqueduct stenosis Atresia of outflow foramina of 4th ventricle (Dandy-walker malformation) Chiari malformation Posterior fossa neoplasm Intraventricular haemorrhage in preterms

28
Q

Causes of communicating hydrocephalus + pathology

A

Failure to reabsorb CSF: Subarachnoid haemorrhage Meningitis

29
Q

S+S hydrocephalus

A

Large head circumference Bulging fontanelles Distended scalp veins Fixed downwards gaze Raised ICP S+S

30
Q

Management of hydrocephalus

A

Insertion of ventriculoperitoneal shunt

31
Q

What is plagiocephaly?

A

Skull asymmetry but normal sutures + fontanelles Due to positional moulding Goes away with time

32
Q

What is a tic?

A

Sudden, quick, coordinated movement Recurs in same part of body - usually face + head Repetitive, involuntary + stereotypic

33
Q

What is Tourette’s syndrome?

A

Multiple motor tics + vocal tics

34
Q

Management of tics

A

Clonidine or risperidone

35
Q

What is the pathology of Duchenne’s?

A

X linked recessive disorder Deletion on short arm of X chromosome Raised CPK

36
Q

S+S of Duchenne’s

A

Waddling gait Language delay Gower’s sign - need to turn prone to rise Pseudohypertrophy of calves Absent knee jerks Lumbar lordosis Progressive muscular atrophy

37
Q

Management of Duchenne’s

A

Exercise Contractures CPAP at night Corticosteroids

38
Q

Features of Becker muscular dystrophy

A

Progresses more slowly than Duchenne’s Average age of onset = 11 Inability to walk by late 20s

39
Q

What are the characteristics of spina bifida?

A

Neural tube defect - failure of fusion of vertebral arch Meningomyelocele = most severe form = baby born with exposed spinal cord Associated with hydrocephalus Paralysis of legs Neuropathic bladder Faecal incontinence

Paediatrics (19 decks)

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