Neurological Conditions Flashcards
(28 cards)
ADHD <5 management
ADHD focused group parent training
Otherwise seek specialist ADHD service
ADHD >5 management
ADHD focuses group parent training
Individualised training if difficulties attending group
Medication if cause significant impairment
- methylphenidate 6 weeks
- lisdexamphetamine second line
- dexamphetamine third
- atomoxetine or guanfacine fourth
Baseline ECG before starting medication
CBT if significant impairment
ADHD monitoring medication
Use symptoms rating scale - Conner’s
Measure height every 6 months
Measure weight every 3 months
Monitor HR and BP every 6 months
ADHD initial
10 week watch and wait
Becker muscular dystrophy
Similar to Duchene muscular dystrophy but slower progression
Same management
Loss of independent ambulating in late 20
Breath holding attacks
Resolve spontaneously
Grow out by 4-5 years old
Behaviours modification therapy with distraction
Consider iron deficiency anaemia as cause
Cerebral palsy risk factors
Antenatal - chorioamnionitis, infection
Perinatal - pre-term birth, encephalopathy, neonatal sepsis, infection
Postnatal - meningitis, head trauma
Cerebral palsy signs
Fidgety or abnormality of movements
Abnormality of tone
Abnormal motor development
Delayed motor milestones
- not sitting by 8 months
- not walking by 18 months
- hand preference before 1 year
- toe walking
Cystic fibrosis management
Physiotherapy
Speech therapy
Occupational therapy
Drooling - anticholinergic
Duchenne muscular dystrophy management
Contractures - physiotherapy
Exercise and psychological support
Glucocorticoids (pred) - delay wheelchair dependence
Ataluren - for patients >5
Vit D and calcium supplement
Nocturnal hypoxia - overnight CPAP
Risk of dilated cardiomyopathy
Epilepsy management
Tonic clonic - sodium valproate, lamotrigine for girls of child bearing age
Absence - ethosuximide, valproate otherwise
Myoclonic - levetiracetam, lamotrigine
Antiepileptic side effects
Valproate - weight gain, hair loss
Carbamazepine - rash, neutropenia
Vigabatrin - visual field restriction, sedation
Lamotrigine - rash
Ethosuximide - nausea and vomiting
Topiramate - drowsiness, weight loss
Gabapentin - insomnia
Levetiracetam - sedation
Benzodiazepine - sedation
Extradural haemorrhage management
Correct hypovolaemima
Urgent evacuation of haematoma
Arrest bleed
Febrile convulsion management during a seizure
6 months to 6 years
Cushion head
Check airway and put in recovery position
If seizure longer than 5 minutes call ambulance or give buccal midazolam/rectal diazepam
- 6-11 months 2.5mg midazolam
- 1-4 years 5mg midazolam
- 5-9 years 7.5mg midazolam
- 6 months-1 year 5mg diazepan
- 2-11 years 5-10mg diazepam
Measure blood glucose if child cannot be roused
Febrile convulsion management after a seizure
Immediate hospital assessment if:
- first or second if never assessed before
- <18 months
- complex seizure
- neuro deficit
- decreased consciousness
- recurrence in 24 hours
- recent antibiotics intake
All other managed at home
Headaches management
<4 yrs - urgent referral
<12 - same day referral if red flag symptoms - waking at night or on waking in morning, meningism, vomiting, aggravated by cough/sneeze/bending down, worsening, within 5 days of head injury, squint or failure of upward gaze
Hydrocephalus management
Ventriculoperitoneal shunt - may require replacement if blockage or infection
Migraine management
Headache diary for 8 weeks to identify trigger
Analgesia - only aspirin if >16
Nasal sumatriptan if >12
Nasal sumatriptan and NSAID
Arrange follow up within 1 month
Migraine prophylaxis
Topiramate or propanolol - require specialist referral
Myotonic muscular dystrophy management
Muscle involvement - physiotherapy, occupational therapy
Muscle pain - NSAID
Myotonia - mexiletine
Difficulties swallowing - SALT
Respiratory function and sleep - noninvasive positive airway pressure ventilation (NIPPV)
Neurocutaneous syndrome management
Neurofibromatosis
- selumetinib
- laser removal of nodules
Tuberous sclerosis
- treat according to symptoms
Status epilepticus definition
Single seizure lasting >5 minutes
> = 2 seizures within a 5-minute period without the person returning to normal between them
Status epileptics management
- ABCDE
- IV lorazepam, otherwise buccal midazolam/rectal diazepam
- if no response - second dose of IV lorazepam
- second line agent - levetiracetam over 5 mins, phenytoin over 20 mins, phenobarbital over 5 mins
- induction of anaesthesia
Subarachnoid haemorrhage management
Surgical clipping and coil embolisation
