neurology Flashcards
(61 cards)
What investigations should you complete a neonate with seizures of unknown cause
glucose/calcium/Mg/U&Es and acid/base status FBC and film CSF analysis blood, urine and CSF cultures cranial US
What additional investigations may you consider once the standard seizure investigations are done
ammonia lactate uric acid liver enzymes biotinidase levels blood and urine amino acids Torch screen MRI brain EEG genetic testing
What are the most common bacterial causes of meningitis in neonates
group B streptococcus
E. Coli
Listeria monocytogenes
What is the most common cause of neonatal encephalitis
vertical transmission of herpes simplex virus
How would you diagnose bacterial meningitis on CSF
isolation of the bacterium
increased WCC
Raised protein
decreased glucose
What does an infantile seizure (west syndrome) present as
sudden, tonic clonic contractions lasting 5-10 seconds with spasms often occurring in quick succession
When does West syndrome usually occur
4-8 months
How does West syndrome present
infantile spasms, often when child is waking up
Who is at risk of developing West syndrome
- previous brain injury <6 months
- brain malformation
- genetic abnormalities
What is the management of West syndrome (infantile spasm)
- prednisilone or vibigatran
- the other of the above
- pyroxidine
- AEDs
What type of spasms do you see in West syndrome
Both extensor and flexor spasms
- Extensor: extend neck and trunk and abduct limbs
- flexor - ‘self hugging’
What would you see on EEG in West Syndrome (infantile spasms)
Hypsarrythmia - chaotic high to very high voltage polymorphic EEG
What are the common causes of seizures in neonates
- hypoxic ischaemic
- encephalopathy
- intracranial haemorrhage
- intracranial infections
- congenital cerebral malformations
- metabolic disorders
What investigations should you do if you feel there is an underlying metabolic disorder causing seizures
glucose electrolyte magnesium calcium metabolic screen (urine and plasma)
What is the most common cause of seizures in a term infant
hypoxic ischaemic encephalopathy
Usually occurs in the first 24-48 hours of life
What is the most common cause of seizures in a pre-term infant
intra-cranial haemorrhage - Cranial US
What are the differential diagnoses of seizures in a neonate
jitteriness + benign neonatal sleep myoclonus
How can you tell between true epileptiform movements and non-epileptiform
stopped by gentle restraint and can be reproduced by sensory stimuli
What is Benign neonatal sleep myoclonus
- bilateral or localised myoclonic jerks only in sleep,
- consistent cessation with arousal
- Normal EEG
- normal neurological examination,
- good outcome
Feautires of jitteriness
movements are stimuli sensitive
movements stop with gentle constraint
predominantly a tremor as opposed to tonic clonic
No CVS changes or eye movements
Feautires of jitteriness
movements are stimuli sensitive
movements stop with gentle constraint
predominantly a tremor as opposed to tonic clonic
No CVS changes or eye movements
Most common presentation of tuberous sclerosis
epilepsy (infantile spasms)
- autism
- cognitive impairment
- neonatal cardiac rhabdomyomas
What is tuberous scelerosis
autosomal-dominant, neurocutaneous, multi-system disorder characterised by cellular hyperplasia, tissue dysplasia, and multiple organ hamartomas
What is a reflex anoxic seizure (reflex asystolic syncope)
Occurs from early infancy and onwards
unpleasant, sudden stimulus leads to a profound vagal discharge resulting in a fast drop in HR and transient asystole.
