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Paediatrics > Neuro > Flashcards

Neuro Flashcards

1
Q

Antenatal risk factors of CP?

A
  • Chorioamnionitis
  • GU/ resp maternal infection
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2
Q

Perinatal risk factors of CP?

A
  • Pre-term birth
  • HIE
  • LBW
  • Neonatal encephalopathy
  • Neonatal infection
  • Maternal infection
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3
Q

Post-natal risk factors of CP?

A
  • TBI <3 years old
  • Meningitis
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4
Q

Spastic CP?

A

70% of CP
- UMN lesion
- Reduced GABA sensitivity (reduced inhibition)
- Increased tone from UMNs

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5
Q

Dyskinetic/ athetoid CP?

A
  • Damage to basal ganglia
  • Lack of movement regulation
  • Dyskinesia/ chorea
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6
Q

Ataxic CP?

A
  • Cerbellar damage
  • Clumsy, poor coorination
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7
Q

Early motor signs of CP?

A
  • Fidgeting
  • Lack of/ abnormal movement (head control, crawling, walking)
  • Feeding difficulties
  • Tone abnormalities
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8
Q

Delayed milestones CP?

A
  • Not sitting 8 months
  • Not walking 18 months
  • Hand preference before 1 year
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9
Q

Red flags for other neuro conditions, not CP?

A
  • No CP risk factors
  • Family hx of degenerative neuro disease
  • Loss developmental milestones
  • Focal neurology
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10
Q

What is the follow up for patients at risk of CP?

A

Follow-up programme by MDT for children up to 2 years

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11
Q

Surgical management CP?

A
  • Dorsal rhizotomy - Electical stimulation reveals nerve root causing spastic symptoms, nerve root is severed (spasticity)
  • Intrathecal baclofen (GABA agonist) (spasticity)
  • Deep brain stimulation (dystonia) - electrodes placed in the brain, neurostimulator placed under the skin of the abdomen, regulates movements
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12
Q

SALT management CP?

A

Eating/ drinking/ swallowing
- Individualised plan for eating, drinking and swallowing

Language
- Posture
- Breath control
- Voice production
- Rate of speech
- Augmented and alternative communication systems (eg. pictures, symbols, speech generation etc)

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13
Q

Management of saliva control CP?

A
  • Anticholinergics (eg. glycopyrronium bromide, transdermal hyoscine hydrobromide)
  • If Anti-Ach contraindicated botox A injection salivary glands (refer to specialist)
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14
Q

Management bone mineral denisty CP?

A
  • Dietary intake Ca2+ and vit D
  • Active movement/ weight bearing programme (physio)
  • Dietarty advice (dietician)
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15
Q

Pain mx CP?

A
  • Stepped approach simple analgesia (WHO pain ladder)
  • Specialist referral
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16
Q

Sleep disturbance CP?

A
  • Sleep hygiene
  • Trial melatonin
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17
Q

Visual impairment mx CP?

A
  • 1/2 children
  • Opthalmological assessment
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18
Q

What % CP hearing impaired?

A

10%

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19
Q

What % CP chronic constipation?

A

60% (3/5), give laxatives

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20
Q

What % CP epilepsy?

A

33% (1/3) give anticonvulsants

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21
Q

Simple febrile seizure?

A
  • <15 minutes
  • Generalised tonic-clonic
  • No repeats within 24 hours of the seizure
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22
Q

What are the excitatory and inhibitory neurotransmitters in the brain?

A

Excitatory: glutamate, binding to NMDA receptors causing Ca2+ influx

Inhibitory: GABA, binding to GABA receptors causing Cl- influx

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23
Q

What are the theorised mechanisms of febrile convulsion?

A
  1. Increase in body temperature increases neuronal excitability
  2. Increased temperature causes hyperventilation leading to respiratory alkalosis which increases neuronal excitability
  3. Cytokines IL-1 stimulate NMDA receptors
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24
Q

Risk factors febrile convulsion

A
  • Genetics (family hx)
  • Age (6m-5yrs peaking at 12-18 months)
  • Rapidly increasing fever
  • High temperature (always >38)
  • HHV-6 (roseola)
  • Vaccines (MMR, stimulate immune system)
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25
Q

Why don’t antipyretics decrease the risk of febrile convulsion recurring?

A

Theorised due to the rapid increase in temperature, when temperature is high and antipyretics given the rapid increase has already happened

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26
Q

Management during febrile convulsion

A
  • Protect head (cushion)
  • Once seizure stops, put in recovery position
  • Time seizure
  • > 5 minutes, call ambulance
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27
Q

Rescue medication for seizure?

A
  • Buccal midazolam
  • Rectal diazepam
28
Q

When can doses of rescue medication be given seizure?

A
  • > 5 mins
  • 10 mins after 1st dose
29
Q

When is ambulance called when rescue medication given for seizure?

A

10 mins after first dose:
- Seizure ongoing
- Twitching ongoing
- Another seizure started before child regains consciousness

Measure blood glucose if child can’t be roused/ is convulsing

30
Q

Doses of midazolam

A
  • 6-11 months: 2.5mg
  • 1-4 years: 5mg
  • 5-9 years: 7.5mg
31
Q

Dose of rectal diazepam

A
  • 6 months - 1 year: 5mg
  • 2-11 years: 5-10mg
32
Q

When is immediate hospital assessment by paediatrician indicated for febrile seizure?

A
  • 1st seizure/ 2nd seizure in child not assessed
  • <18 months (signs of CNS infection may be subtle)
  • Diagnostic uncertainty
  • Complex seizure
  • Focal neurology
  • Decreased consciousness prior to seizure
  • Seizure in same illness
  • Child taken abx (can mask CNS infection)
  • Anxious parents
  • No obvious focus of infection
33
Q

When is febrile seizure referred to paediatric neurologist?

A
  • Neurodevelopmental delay
  • Signs of neurocutaneous syndrome
  • Signs of metabolic disorder
34
Q

Which children with a headache should be referred?

A
  • All children under 4 (urgent neuro assessment)
  • Children under 12 with red flag symptoms
35
Q

What are the red flag symptoms for headache under 12?

A
  • Waking at night or present on waking in the morning
  • Features of meningism
  • Vomiting or ataxia
  • Aggravated by coughing, sneezing, bending down
  • Progressively worsening
  • Change in consciousness or lethargy
  • Within 5 days of head injury
  • Squint or failure of upwards gaze
  • New onset cognitive dysfunction
36
Q

What is the managment of extradural haemorrhage in children?

A
  • Correct hypovolaemia
  • Urgent evacuation of haematoma
  • Arrest bleeding
37
Q

When do breath holding attacks resolve?

A

4-5 years old

(Common in children between 6 months and 6 years)

38
Q

Management breath holding attacks?

A
  • Behaviour modification therapy with distraction
  • Consider IDA as a cause and investigate with bloods
39
Q

What are the behavioural modifications with distraction techniques for breath holding attacks?

A

Behavioural modification
- Positive reinforcement eg. reward when the child manages frustration without holding breath
- Ignoring behaviour
- Consistency, ensuring all caregivers respond to BHA the same way

Distraction techniques
- Engaging the child (conversation, toys and objects)
- Physical diversion (tickling etc)

40
Q

What are partial epileptic seizures?

A

One hemisphere/ lobe
- Simple partial = conscious during the seizure
- Complex partial = impaired consciousness/ unconscious during seizure

41
Q

What is a Jacksonian March?

A

Type of epileptic seizure where contractions start in one muscle group and spread throughout the body (usually one side)

42
Q

What are generalised seizures?

A

Affecting both hemispheres, usually unconscious

43
Q

What are the types of generalised seizures?

A
  • Tonic
  • Atonic
  • Clonic
  • Tonic-clonic (most common)
  • Myoclonic (short muscle twitches, patient remains conscious)
  • Absence
44
Q

What is the difference between tonic and myotonic seizures?

A

Tonic - sudden sustained stiffening of the body, lasts 20s, usually unconscious

Myotonic - jerking of specific muscles or muscle groups, shock like contractions, 2-3s

45
Q

What is Todd’s paralysis?

A

Weakness/ paralysis following a seizure

  • Usually one side of the body
  • Lasts a few minutes - hours (average 15 hours)
  • Self-resolves
46
Q

When should patients with suspected epilepsy be referred?

A

When first epileptic seizure is suspected, refer to first fit clinic

47
Q

Who can assist families with epilepsy in the community?

A

Epilepsy specialist nurse

48
Q

Which type of epilepsy is treatment not usually given for?

A

Childhood rolandic epilepsy

(seizures involving twitches, numbness, tingling of the face or tongue)

49
Q

What is the treatment for childhood absence epilepsy?

A

Maximise educational potential and support social development

50
Q

Which seizures can carbamazepine worsen?

A

Absence and myoclonic seizures

51
Q

Which children with epilepsy are given rescue therapy?

A

Children with prolonged epileptic seizures (>=5 minutes)

52
Q

When can anti-epileptic drugs be discontinued?

A

After 2 years free of seizures

53
Q

What is the first line management for tonic-clonic seizures?

A
  • Sodium valproate (not of childbearing potential)
  • Lamotrigine or levetiracetam
54
Q

What can lamotrigine exacerbate?

A

Myoclonic seizures

55
Q

What is the first line managment for absence seizures?

A

Ethosuximide

(2nd line valproate or lamotrigine in females CBA)

56
Q

What is the first line management for myoclonic seizures?

A

Valproate or levetiracetam

57
Q

What is the first line management for focal seizures?

A

Levetiracetam, lamotrigine

58
Q

Side effects of sodium valproate

A
  • Weight gain
  • Hair loss
  • Rare idiosyncratic liver failure
59
Q

Side effects of carbamazepine

A
  • Rash
  • Neutropaenia
  • Hyponatraemia (SIADH)
  • Ataxia
  • Liver enzyme induction
60
Q

Side effects of lamotrigine

A

Rash

61
Q

Side effects of ethosuximide

A

Nause and vomiting

62
Q

Side effects of levetiracetam

A

Sedation (rare)

63
Q

Side effects of benzodiazepines

A

(Facilitate binding of GABA to GABA receptors to inhibit neuronal impulses)

  • Sedation
  • Tolerance
  • Increased secretions
64
Q

What are the management options for children with intractable epilepsy?

A
  • Ketogenic diets
  • Vagal nerve stimulation (regulates neurotransmitter release)
  • Surgery (if there is a well localised structural cause)
65
Q

When is driving allowed in epilepsy?

A

After 1 year free of seizures

Paediatrics (16 decks)

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