Flashcards in Neuro Deck (117)
What are periodic syndromes?
Syndromes which affect children and are often precursors of migraine
Child is well between episodes
What is cyclical vomiting?
A periodic syndrome.
Recurrent stereotyped episodes of vomiting and intense nausea associated with pallor and lethargy
Child is well in between episodes
What is abdominal migraine?
Idiopathic recurrent disorder
Episodic midline abdominal pain in bouts lasting 1-72 hr
Pain moderate to severe in intensity
Associated with vasomotor symptoms, nausea and vomiting
What is benign paroxysmal vertigo of childhood?
Characterised by brief episodes of vertigo which occur without warning and resolve spontaneously
Children otherwise healthy with normal neuro, auditory and vestibular exam
When can sumatriptan be given in children with headaches? Route
Licensed for use in children over 12 years of age
What are febrile seizures?
Seizure accompanied by a fever in absence of intracranial infection due to meningitis or encephalitis
Incidence and age prevalence of febrile seizures?
3% of children between 6 months and 6 years
Inheritance of febrile seizures
Genetic predisposition with 10% chance if first degree relative had them
When during illness does seizure usually occur
Early on in viral infection when temperature is rising rapidly
What sort of seizures are febrile seizures?
Usually tonic-clonic seizures
What % of 1st febrile seizure will have further ones
What increases likelihood of having more febrile seizures? x4
Earlier on in illness
Younger age of child
Lower temperature at time of seizure
Positive family history
When is there an increased risk of developing epilepsy with febrile seizures? x3
If complex febrile seizures
Aka, prolonged, repeated in same illness or focal seizures
If febrile seizure goes on longer than 5 mins
Buccal midazolam or rectal diazepam
What happens in breath-holding attacks?
Happens in toddlers when they are upset
Child cries, holds breath, goes blue. Will sometimes briefly lose consciousness but rapidly recover
What is reflex anoxic seizure
Occurs in infants or toddlers when scared or shocked (head trauma, cold food, fright or fever)
Becomes pale and falls to the floor
Hypoxia may induce tonic-clonic seizure
Due to cardiac asystole from vagal inhibition
Child recovers quickly after brief seizure
Pseudoseizures vs fabricated seizures
Pseudoseizures - child feigns seizure
Fabricated - by parents
When do you do metabolic investigations with seizures?
When there is developmental regression or when seizures are related to feeds or fasting
What is West syndrome?
Violent flexor spasms of head, trunk and limbs followed by extension of arms
Flexor spasms last 1-2s and usually 20-30 spasms
Often occur on waking
2/3 have underlying neuro cause
What age is West syndrome?
How do you treat West Syndrome? Response rate and future development
Vigabatrin or corticosteroids
Good response in 30-40%
Most lose skills and develop learning disability or epilepsy
What is Lennox-Gastaut syndrome?
Multiple seizure types - mostly drop attacks, tonic seizures and atypical absences
Also have neurodevelopmental arrest/regression and behavioural disorder
Age and prognosis of Lennox-Gastaut
Often other complex neurological problems and history of infantile spasms
First line for tonic-clonic seizures x2
Valproate and carbamazepine
First line for absence seizure x2
Valproate and ethosuximide
First line for myoclonic seizure x1
First line for focal seizures x2
Carbamazepine and valproate
Signs of myopathy in children?
Waddling gait or positive Gowers sign (need to turn prone to rise to standing, use arms to stand up)
When is positive Gowers sign normal?
Before the age of 3 years