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Neurology Flashcards

1
Q

What is syncope

A

Temporary loss of consciousness due to disruption to blood flow to the brain

Often leads to a fall

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2
Q

How might a patient have felt before an episode of syncope

A

Hot or clammy

Sweaty

Heavy

Dizzy or light headed

Vision going blurry or dark

Headache

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3
Q

What are the primary causes of syncope in children

A

Simple fainting

Dehydration

Missed meal

Extended standing in warm environment

Vasovagal response to stimuli (surprise, pain)

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4
Q

What are the secondary causes of syncope in children

A

Hypoglycaemia

Dehydration

Anaemia

Infection

Anaphylaxis

Arrhythmias

Valvular heart disease

Hypertrophic obstructive cardiomyopathy

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5
Q

What investigations are needed for syncope

A

Lying standing blood pressure

ECG (consider 24 hour tape)

ECHO

Bloods (normal, glucose)

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6
Q

What is the management for syncope

A

Reassurance

Simple advice (stay hydrated, avoid missing meals, sit down when experiencing symptoms)

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7
Q

What is epilepsy

A

Umbrella term for conditions where there is a tendency to have seizures

Abnormal activity in the brain

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8
Q

What are generalised tonic-clonic seizures

A

Loss of consciousness

Muscle tensing and jerking

May have: tongue biting, incontinence, groaning, irregular breathing

Prolonged post-ictal period

Management: sodium valproate (first line), lamotrigine, carbamazepine

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9
Q

What are focal seizures

A

Start in temporal lobe

Affect hearing, speech, memory and emotions

May have: hallucinations, flashbacks, deja vu, doing strange things on autopilot

Management: lamotrigine or carbamazepine (first line), sodium valproate

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10
Q

What are absence seizures

A

Blank, stare into space

Abruptly return to normal

Unaware of surroundings, do not respond

Usually last 10-20 seconds

Most stop as child grows up

Management: sodium valproate, ethosuximide

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11
Q

What are atonic seizures

A

Aka drop attacks

Brief lapses in muscle tone

Usually last less than 3 minutes

Usually begin in childhood

Management: sodium valproate (first line), lamotrigine

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12
Q

What are myoclonic seizures

A

Sudden brief muscle contractions

Awake during episode

Management: sodium valproate (first line), lamotrigine, levetiracetam, topiramate

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13
Q

What are infantile spasms

A

Start at around 6 months

Clusters of full body spasms

Poor prognosis

Management: prednisolone, vigabatrin

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14
Q

What are the investigations for epilepsy

A

Allow one simple seizure before investigation

History

Video

EEG

MRI brain if: first seizure in under 2, focal seizure, no response to first line management

ECG

Bloods (normal + glucose)

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15
Q

What general advice should be given to patients with epilepsy

A

Take showers, not baths

Close supervision when swimming

Caution with weights

Caution with traffic

Caution with hot/heavy/electrical equipment

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16
Q

What is the management for seizures

A

Put patient in safe position

Recovery position if possible

Put something soft under head

Remove obstacles that could lead to injury

Note start and end times

Call ambulance if: > 5 mins, first seizure

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17
Q

What is status epilepticus

A

A medical emergency

Seizure lasting > 3 mins

More than 3 seizures in 1 hour

Management: IV lorazepam (repeat after 10 mins), IV phenytoin, consider intubation and ventilation, buccal midazolam, rectal diazepam

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18
Q

What are febrile convulsions

A

Seizure in a child with a fever

At 6 months - 5 years

Simple: generalised, tonic-clonic, last < 15 mins, only once during a febrile episode

Complex: partial or focal, last > 15 mins, multiple times during a febrile episode

Small risk of developing epilepsy

Management: control fever, call ambulance if last > 5 mins

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19
Q

What are breath holding spells

A

Involuntary episodes of a child holding their breath

Triggered by something upsetting/scaring them

At 6-18 months

Most outgrow them by age 4-5

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20
Q

What are cyanotic breath holding spells

A

When child very upset and crying

After letting out a long cry, stop breathing, become cyanotic, lose consciousness

Regain consciousness and restart breathing within 1 minute

Tired and lethargic after episode

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21
Q

What are reflex anoxia seizures

A

When child is startled

Vagus nerve sends strong signal to heart to stop beating

Go pale, lose consciousness, may have some muscle twitching

Resolves in under 30 seconds

22
Q

What is the management for breath holding spells

A

Educate and reassure parents

Treat any iron deficiency anaemia (linked to future episodes)

23
Q

What are tension headaches

A

Band-like pattern around head

Resolve gradually over 30 mins

No visual changes or pulsatile sensations

Quiet, stop playing, pale, tired

Triggers: stress, fear, discomfort, skipped meals, dehydration, infection

Management: reassurance, analgesia, regular meals, hydration

24
Q

What are migraines

A

Occur in attacks

With or without aura

Unilateral, severe, throbbing, take a long time to resolve

Associated with: visual aura, photophobia, phonophobia, nausea, vomiting, abdominal pain

Management: rest, fluids, simple analgesia, antiemetics

Consider prophylactic treatment (propranolol, pizotifen, topiramate)

25
What are the causes of headaches in children
Tension headache Migraine ENT infection Analgesic headache Problems with vision Raised intracranial pressure Brain tumour Meningitis Encephalitis Carbon monoxide poisoning
26
What is cerebral palsy
Permanent neurological problems resulting from damage to the brain around birth Not progressive
27
What are the causes of cerebral palsy
Antenatal: maternal infection, trauma during pregnancy Perinatal: birth asphyxia, pre-term birth Postnatal: meningitis, severe neonatal jaundice, head injury
28
What are the types of cerebral palsy
Spastic hypertonic (upper motor neurone damage) Dyskinetic (problems controlling muscles, damage to basal ganglia) Ataxia (problems with coordinating movement, damage to cerebellum) Mixed
29
How might a patient with cerebral palsy present
Failure to meet milestones Increased/decreased tone Hand preference before 18 months Problems with coordination, speech, walking Feeding or swallowing problems Learning difficulties
30
What might you find on examination of the gait of a patient with cerebral palsy
Hemiplegic/diplegic (upper motor neurone lesion) Broad based/ataxic (cerebellar lesion) High stepping (lower motor neurone lesion) Waddling (pelvic muscle weakness) Antalgic (localised pain)
31
What are the complications associated with cerebral palsy
Learning disability Epilepsy Kyphoscoliosis Muscle contracture Hearing and visual impairment GOR
32
What is a squint
Misalignment of the eyes Experience double vision Children have a lazy eye Concomitant: due to differences in control of extraocular muscles Paralytic: due to paralysis of one or more extraocular muscle
33
What are the causes of squints
Usually idiopathic Hydrocephalus Cerebral palsy Space occupying lesion Trauma
34
What are the investigations for squint
General inspection Eye movements Fundoscopy Visual acuity Hirschberg's test and cover test (specific to squints)
35
What is the management for squints
Start treating before age 8 (when visual fields still developing) Occlusive patch (cover good eye, force weak eye to develop) Atropine drops (in good eye to blur vision, force weak eye to develop)
36
What is hydrocephalus
Abnormal buildup of CSF in brain or spinal cord Problems with draining or absorbing CSF
37
What are the congenital causes for hydrocephalus
Aqueduct stenosis (problem with drainage) Arachnoid cyst (block outflow of CSF) Arnold-Chiari malformation (cerebellum herniates through foramen magnum, block outflow of CSF) Chromosomal abnormalities
38
How might a patient with hydrocephalus present
Enlarged and rapidly growing head circumference Bulging anterior fontanelle Poor feeding Vomiting Poor tone Lethargy
39
What is the management for hydrocephalus
Ventriculoperitoneal shunt Complications: infection, blockage, excessive drainage, intraventricular haemorrhage Need to be replaced every 2 years as child grows
40
What is craniosynostosis
Skull sutures close prematurely (before age 1) Abnormal head shape Restriction to brain growth
41
What are the investigations for craniosynostosis
Skull X-ray CT head
42
What is the management for craniosynostosis
Mild: monitor and follow up Severe: surgical reconstruction
43
What is plagiocephaly
Flattening of one side of baby's head Due to baby resting head on a particular point Present at 3-6 months with abnormal head shape
44
What is the management for plagiocephaly
Look for congenital muscular torticollis (shortened SCM on one side) Reassurance (most return to normal shape as child grows)
45
What is muscular dystrophy
Umbrella term for genetic conditions that cause gradual weakening and wasting of muscles Commonly see Gower's sign (kids get on hands and feet and then push off to stand up, a sign of proximal muscle weakness)
46
What is Duchenne's muscular dystrophy
Defective gene for dystrophin X-linked recessive Presents at age 3-5, with weakness of muscles around pelvis Usually wheelchair bound by teenage years Life expectancy 25-35 Management: oral steroids (slow progression), creatine supplements (improve muscle strength)
47
What is Becker's muscular dystrophy
Symptoms appear at 8-12 Muscle weakness around hips at age 3-5 Some need wheelchair in 20s and 30s Management: oral steroids (slow progression), creatine supplements (improve muscle strength)
48
What is myotonic dystrophy
Presents in adulthood Progressive muscle weakness Prolonged muscle contractions Cataracts Arrhythmias
49
What is facioscapulohumeral muscular dystrophy
Presents in childhood Weakness around face, shoulders, and arms Sleep with eyes slightly open Weakness in pursed lips
50
What is oculopharyngeal muscular dystrophy
Presents in late adulthood Weakness of ocular muscles (bilateral ptosis, restricted eye movements) Difficulty swallowing
51
What is spinal muscular atrophy
Autosomal recessive Progressive loss of motor neurones Progressive muscle weakness Get lower motor neurone signs (fasciculations, reduced muscle bulk, reduced tone, reduced power, reduced or absent reflexes) Types 1 to 4 (1 most severe)
52
What is the management for spinal muscular atrophy
Supportive MDT management (physio, may need NIV, may need PEG feeding)

Paeds (17 decks)

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