Neuro

Question 1

What are some causes of gross motor delay?

Answer 1

• Cerebral palsy
• Ataxia
• Myopathy
• Spina bifida
• Visual impairment

Question 2

What are some causes of fine motor delay?

Answer 2

• Dyspraxia
• Cerebral palsy
• Muscular dystrophy
• Visual impairment
• Congenital ataxia (rare)

Question 3

What are some causes of global developmental delay?

Answer 3

• Down’s syndrome
• Fragile X syndrome
• Rett syndrome
• Foetal alcohol syndrome
• Metabolic disorders

Question 4

What are some causes of language delay?

Answer 4

• Specific social circumstances - multiple languages, siblings do all talking
• Hearing impairment
• Learning disability
• Neglect
• Autism
• Cerebral palsy

Question 5

What is a potential management option for language delay?

Answer 5

SALT, audiology and health visitor; consider referring to safeguarding

Question 6

What are potential causes of personal and social delay?

Answer 6

• Emotional and social neglect
• Parenting issues
• Autism

Question 7

What is a febrile convulsion?

Answer 7

Seizure occurring in a child with a high fever

Question 8

What age children will experience febrile convulsions?

Answer 8

6 months to 5 years of age

Question 9

What characterizes a simple febrile convulsion?

Answer 9

Generalized, tonic clonic seizure; <15 minutes - only during single febrile illness

Question 10

What characterizes a complex febrile convulsion?

Answer 10

Partial or focal seizure; >15 minutes, multiple times during same febrile illness

Question 11

What is the typical presentation of a patient with a febrile convulsion (consider age too)?

Answer 11

~18 months, 2-5 minute tonic-clonic seizure during high fever. Fever caused by underlying viral infection (e.g. tonsillitis)

Question 12

What are key differentials to consider when a child presents with a possible febrile convulsion?

Answer 12

• Epilepsy
• Meningitis, encephalitis, other neuro issue (e.g. cerebral malaria)
• IC space occupying lesions (e.g. brain tumour, IC haemorrhage)
• Syncopal episode
• Electrolyte abnormalities
• Trauma (consider safeguarding)

Question 13

What would prompt an ambulance to be called when a child suffers a possible febrile convulsion?

Answer 13

> 5 minutes (1st episode should be trip to hospital anyway)

Question 14

Which carries higher risk of future epilepsy development: simple/complex febrile convulsions?

Answer 14

Simple slightly higher than gen. population
Complex 10-20% higher (worse prognosis)

Question 15

What are the clinical feature of generalized tonic-clonic seizure?

Answer 15

• Tonic-clonic
• Tongue biting
• Incontinence
• Groaning
• Irregular breathing
• Post-ictal period

Question 16

What is the 1st line management for generalized tonic-clonic seizure?

Answer 16

Sodium valproate

Question 17

What is the 2nd line management for generalized tonic-clonic seizure?

Answer 17

Lamotrigine, carbamazepine

Question 18

What are the clinical features of focal seizures?

Answer 18

• Temporal lobe; hearing, speech, memory emotions (hallucinations, memory flashback, déjà vu, autopilot)

Question 19

What is the 1st line management for focal seizures?

Answer 19

Carbamazepine
Lamotrigine

Question 20

What is the 2nd line management for focal seizures?

Answer 20

Sodium valproate
Levetiracetam

Question 21

What characterizes a absence seizure?

Answer 21

Blank and staring into space before returning to normal after around 10-20 seconds.

Question 22

What is the 1st line management for absence seizure?

Answer 22

Sodium valproate or ethosuximide

Question 23

What characterizes a atonic seizure?

Answer 23

Drop attack, usually <3 minutes

Question 24

What is the 1st line management for a atonic seizure?

Answer 24

Sodium valproate

Question 25

What is the 2nd line management for a atonic seizure?

Answer 25

Lamotrigine

Question 26

What are the clinical features of myoclonic seizure?

Answer 26

Sudden, brief muscle contractions - jumping (often as part of juvenile myoclonic epilepsy)

Question 27

What is the 1st line for a myoclonic seizure treatment?

Answer 27

Sodium valproate

Question 28

What is the treatment for infantile spasms?

Answer 28

Often carries poor prognosis Pred, vigabatrin

Question 29

What are investigations that are performed for a child who has suffered seizures?

Answer 29

EEG, MRI ECG, blood electrolytes, blood glucose, blood cultures/urine cultures/LP.

Question 30

When should an EEG be considered for a patient suffering seizures?

Answer 30

After 2nd simple tonic-clonic seizure

Question 31

What would lead to an MRI being requested for a patient suffering a seizure?

Answer 31

1st seizure child <1 year old Focal seizure No response to 1st line anti-epileptic medication

Question 32

What should be given should the patient be in status epilepticus and suffering seizures for 10 minutes?

Answer 32

IV Lorazepam

Question 33

A patient suffering status epilepticus who has become more stable and after lorazepam should be given?

Answer 33

IV phenytoin or phenobarbital (+intubate and ventilate)

Question 34

What is status epilepticus?

Answer 34

>5 minute seizure or 2 or more seizures without regaining consciousness

Question 35

What are side effects of sodium valproate?

Answer 35

- Teratogenic - try to avoid in pregnancy age girls - Liver damage and hepatitis - Hair loss - Tremor

Question 36

What are the side effects of carbamazepine?

Answer 36

- Agranulocytosis - Aplastic anaemia - P450 system induction so beware of many drug interactions

Question 37

Which system can be stimulated as a side effect of carbamazepine?

Answer 37

P450 system

Question 38

What are the side effects of phenytoin?

Answer 38

- Folate and vitamin D deficiency - Megaloblastic anaemia - Osteomalacia

Question 39

Which types of anaemia is caused by carbamazepine and phenytoin respectively?

Answer 39

Carbamazepine - aplastic anaemia Phenytoin - megaloblastic anaemia

Question 40

What are the side effects of ethosuximide?

Answer 40

Night terrors Rashes

Question 41

What are the side effects of Lamotrigine?

Answer 41

- Steven-Johnson syndrome - DRESS syndrome - Leukopenia

Question 42

What is cerebral palsy?

Answer 42

Permanent non progressive condition resulting from damage to the brain around the time of birth (huge range in symptom severity)

Question 43

What are antenatal causes of cerebral palsy?

Answer 43

1. Maternal infection 2. Trauma during pregnancy

Question 44

What are perinatal causes of cerebral palsy?

Answer 44

1. Birth asphyxia 2. Pre-term birth

Question 45

What are postnatal causes of cerebral palsy?

Answer 45

1. Meningitis 2. Severe neonatal jaundice 3. Head injury

Question 46

Pathophysiology of spastic hypertonia?

Answer 46

Damage to the UMN causing increased tone

Question 47

What is the pathophysiology of dyskinetic cerebral palsy?

Answer 47

Basal ganglia are damaged - athetoid movements, oro-motor problems; hyper/hypotonia

Question 48

What is the pathophysiology of ataxic cerebral palsy?

Answer 48

Cerebellum damage - coordinated movement problems

Question 49

What is the pathophysiology of mixed cerebral palsy?

Answer 49

Spastic, dyskinetic and/or ataxic features mix

Question 50

Name the patterns of cerebral palsy?

Answer 50

Monoplegia - one limb Hemiplegia - one side of the body Diplegia - four limbs mostly legs Quadriplegia - four limbs affected more severely (seizures, speech disturbance, other impairments).

Question 51

What is the tale-tale sign of a potential cerebral palsy diagnosis?

Answer 51

Hand preference prior to 18 months

Question 52

What may be found on neurological examination for a patient with cerebral palsy?

Answer 52

Increased muscle tone and spasticity in legs Hemiplegic/diplegic gait UMN signs (muscle bulk preserved, hypertonia, slightly reduced power, brisk reflexes) Athetoid movements Cerebellar involvement - coordination may need testing

Question 53

Who may be involved in the care of a complex cerebral palsy patient?

Answer 53

MDT to include: - Physio - OT - SALT (consider NGT or PEG) - Dietician - Orthopaedic surgeon - Paediatrician (medication control) - Social worker - Charity and support group

Question 54

What medication may be prescribed by a paediatrician for a cerebral palsy patient?

Answer 54

Muscle relaxants - baclofen Anti-epileptic medication Glycopyrronium bromide (drooling)