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Neurology Flashcards

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1
Q

What is CP?

A

A group of disorders caused by a non progressive disturbance of the developing brain affecting movement and posture as well as activity limitations and associated disturbances.

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2
Q

What is the pathophysiology of organophosphate poisoning?

A

Acetylcholinesterase inhibitor - acetylcholine not broken down = increased parasympathetic sx = hypersalivation, bronchospasm, lacrimation, muscle weakness, headache, slurred speech, ataxia, confusion

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3
Q

How do you treat organophosphate poisoning?

A

Atropine to reverse cholinergic signs
Pralidoxime (cholinesterase reactivator)

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4
Q

What is the definition of microcephaly?

A

Less than two standard deviations below the mean for race, age and sex

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5
Q

What is the definition of microcephaly?

A

More than 2 standard deviations for race, age and sex.

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6
Q

How does cerebral palsy present?

A

> UMN signs = increased tone (spastic/rigid), increased reflexes, pathological reflexes
Developmental delay (motor/global)
+/- microcephaly
abnormal movements (dystonia)

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7
Q

What is the dilemma of imaging in CP patients?

A

The imaging can identify the point in development when the insult occurred, but it cannot indicate the CAUSE

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8
Q

What neurogenetic disorders mimic cerebral palsy?

A

Dyskinetic disorders
>mitochondrial disorders
>neurotransmitters
>glucose transport defects
>brain iron accumulation
>organic acid disorders

Spastic disorders
>hereditary spastic paraplegias
>lysosomal storage disorders
>disorders of forebrain cleavage
>migrational disorders

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9
Q

What are the general principles of the management of CP patients?

A

> Individualise
If a child sits independently before age 2, he will walk
Activity based rehab interventions induce neuroplasticity
Very early intervention, close to the time of incident, optimises neuroplasticity
90% of movement potential is achieved by 5years of age or less if severe
there is no single treatment that will allow a patient to jump from one level up to another

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10
Q

What are complications of cerebral palsy?

A

Pain
Constipation
Behaviour
Reflux
Epilepsy
Spasticity

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11
Q

What are the risk factors for developing CP?

A

Prenatal
>poor maternal health
>epilepsy
>genetic predisposition
>hydrocephalus
>ANC bleeding

Perinatal
>poor maternal health
>small for GA
>Premature
>HIE
>infections

Postnatal
>infections
>trauma
>environmental factors
>vascular (AVMs, strokes, thrombosis)

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12
Q

What are the signs of raised intracranial pressure?

A

> vomiting
headache
Diplopia
bulging fontanelle
papilloedema
diastasis of sutures
worse on lying down
worsened by coughing/sneezing
wakes child from sleep

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13
Q

What are the associated problems with CP?

A

Intellectual impairment
Learning disabilities
Epilepsy
Language disorders
Vision and hearing abnormalities
Behavioural problems
Malnutrition

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14
Q

What are some possible clinical features of cerebral palsy?

A

> hypertonic = fisting, leg scissoring, equines deformity
truncated hypotonia = asked head lag, opisthotonus due to excessive truncated and nuchal tone
brisk deep tendon reflexes = positive babinski reflex,

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15
Q

What is the differential diagnosis of a floppy infant?

A

> sick child
-cardiac
- malnutrition
-any acute illness
syndromic
neurological
-UMN - cerebral/cerebellar,
-LMN - muscular dystrophy, spinal muscular atrophy, NMJ
metabolic/hyperlaxity

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16
Q

What are the signs of UMN lesions?

A

Hyperreflexia
NOT weak
Evidence of CNS involvement (delayed milestones)

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17
Q

What are signs of LMN lesions?

A

Absent/decreased reflexes
Weak/decreased power

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18
Q

What is epilepsy?

A

> /= 2 unprovoked/reflex seizures >24hours apart
OR
One unprovoked seizure and a probability of >60% of further seizures over the next 10 years
OR
Diagnosis of an epilepsy syndrome

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19
Q

What is an epilepsy syndrome?

A

Seizure types + specific EEG patterns + brain imaging + genetic profile = cluster of features with recognisable pattern = determines further investigations + specific treatment

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20
Q

What is a febrile seizure?

A

Seizures in children between 6months and 5 years in association with fever but without evidence of intracranial infection0

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21
Q

How are febrile seizures classified?

A

Simple febrile seizures
Vs
Complex febrile seizures

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22
Q

What’s the difference between simple febrile seizures and complex febrile seizures?

A

Simple
>generalised tonic cloning
>lasts <15mins
>doesn’t recur within 24hrs

Complex
>focal
> usually >15mins
>cluster of 2+ in 24hrs

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23
Q

How do you manage febrile seizures?

A

Identify cause = exclude meningitis with LP
No CT/MRI/EEG warranted

Tx:
>antiepileptic drugs long term is NOT indicated unless complex = phenobarb
>rectal diazepam
>antipyretics

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24
Q

What factors does the drug of choice for epileptic seizures depend on?

Study These Flashcards
A

> age
seizure type/syndrome
dosage according to weight
least side effects
dosage schedule
family and patient
availability
cost

25
What drug is first line tx for absent seizures?
Sodium valproate
26
What is the first line drug tx for generalised and focal seizures?
Carbamazepine
27
What are the contraindications for a LP?
>low platelets/coagulopathy (haematoma risk) >local infection >previous surgery in that area >raised ICP >haemodynamically unstable/resp compromise >decreased LOC <13 >focal deficit eg unequal pupils
28
What positioning is needed for an LP?
Lateral recumbent position (spine perpendicular to bed) OR Fetal position (spine parallel to bed)
29
What layers do you go through when going an LP?
1)skin and subcut tissue 2)supraspinous ligament 3)interspinous ligament 4)ligamentum flavour 5)epidural space 6)dura 7)subarachnoid space
30
What tests would you do on the CSF?
1)measure opening pressure 2)dipstix 3)cell count 4)gram stain 5)capsular antigen 6)culture 7)biochemistry 8)other CSF specimen for virology
31
What are NORMAL CSF findings?
No neutrophils 0-6 lymphocytes Protein 0,15-0,45 Glucose 3,6-5,6
32
What are the CSF findings in bacterial infections?
Predominantly neutrophils Increased protein Decreased glucose Polymorphs
33
What are the CSF findings in viral infection?
Predominantly lymphocytes Increased protein (less than bacterial) Glucose within normal limits
34
What are the CSF findings of TB meningitis?
Predominantly lymphocytes Grossly increased protein Grossly decreased glucose (NB check CSF/serum glucose ratio)
35
What are complications of lumbar puncture?
Haematoma Herniation Pain Post puncture headache CSF leakage Subarachnoid epidermal cysts Cardioresp arrest Infection
36
What are the steps to follow when called to casualty for a seizing child?
1) stabilise/resus (ABC) 2) quick history 3) examination 4) diagnostic tests 5) treatment
37
What is NB to remember to check when resusing a seizing child?
Check glucose!!
38
What do you ask on your quick history when you have a child seizing in casualty?
Acute onset? >infection >bleed >stroke >toxins >seizures >metabolic derangement Subacute onset? >brain tumor >hydrocephalus >inborn errors of metabolism
39
What do you look for in your examination of a child seizing in casualty?
Vitals Intracranial pressure Meninges irritation Skull = signs of trauma/non-accidental injury Seizure activity = tongue laceration/incontinence Neuro exam = GCS, breathing pattern,eyes, posture, focal signs (tone, reflexes, brain stem reflexes, CN) Rest of body clues
40
What breathing pattern indicates midbrain lesion?
Central neurogenic hyperventilation
41
What pattern of breathing indicates medullary lesion?
Ataxic breathing
42
What pupil reaction indicates lesion in midbrain?
Midposition, fixed
43
What pupil reaction indicates lesion in pons?
Pinpoint
44
How do you treat raised intracranial pressure?
Head upright Restrict fluids Normocarbia Mannitol Specific cause >meningitis = antibiotics/antivirals >SOL = neurosurgery >ingestion = remove toxin >status = see protocol
45
How do you treat a child <1/neonate who has status epilepticus?
1) phenobarbital 20mg/kg 2)phenytoin 20mg/kg if previous step failed (NOT VALPROATE) 3) thiopentone OR midazolam infusion
46
How do you treat a child more than 1y old with status epilepticus?
1) lorazepam 0,1mg/kg IVI OR diazepam 0,3-0,5 mg/kg IV or PR Repeat x1 2) phenytoin 20mg/kg in SALINE 20-30min infusion to avoid cardiac arrest OR valproate 20mg/kg over 5mins (NOT IF CHILD YOUNGER 2y) 3) ICU, EEG, INTUBATE. thiopentone infusion (keep on infusion until 48hrs seizure free) OR midazolam 0,3mg/kg loading dose then 0,1-0,4mg/kg/hr
47
What are red flag signs for autism?
12 months = no babbling, no pointing/waving 16 months = no single words 24 months = no spontaneous 2 word phrases Any stage = loss of language or social skills
48
What developmental milestones should be met at 3 months?
GM: lifts head in prone FM: Hands open, follow 180 degrees Coms: coo
49
What developmental milestones should be met at 6 months?
GM: Roll over both ways, sit with support, braces shoulders when pulls to sit FM: transfer hand to hand, palmar grasp Comms: babbles Social: express emotion, takes everything to mouth
50
What developmental milestones should be met at 12 months?
GM: bear walks, stands independently FM: release objects on request, throws, places cubes in container Comms: nouns “where’s mommy”, knows name, knows one word phrases Social: finger eats
51
What developmental milestones should be met at 2 years?
GM: jumps, kicks ball, walk upstairs both feet on step, runs FM: 6 cube tower, circle shapes, hand preference, match puzzle shapes, turn multiple pages Comms: names one body part, points at 7body parts, knows pronouns, verbs “what do you eat with” Social: can dress, possessive
52
What developmental milestones should be met at 3 years?
GM: walks up stairs individually FM: 9/bridge, copies circle, draw straight line, can use scissors, turn individual pages Comms: adjective negative “which one is red” “which one is NOT the animal”, knows name and gender, can count to 10 Social: uses fork, empathy, bowel trained, interactive and cooperative play
53
What developmental milestones should be met at 4 years?
GM: jumps on one foot, hopscotch, walk down stairs individually FM: 12blocks/step, copy a cross, draw person with head, arms and legs Comms: complex instruction plan, knows age, address, points at colours, knows 4 numbers Social: handles buttons, bladder trained, washes hands, make believe play
54
What development milestones do you expect in a 5 year old?
GM: walk in straight line FM: draw square, draw triangle, cut along lines Comms: knows 10 numbers, recites alphabet Social: uses knife, chooses friends, does laces
55
What are red flag signs in a child with a headache?
>signs of raised ICP >signs of meninges irritation >neurological deficits/seizures >described as “worst headache ever” -subarachnoid haemorrhage
56
What are the clinical signs of cerebellar dysfunction?
>ataxia >nystagmus >intention tremor >dysarthria >dysdiadocokinesis >past pointing
57
What is friedrichs ataxia?
A progressive neurodegenerative disorder (AR) causing progressive damage to your nervous system and movement problems
58
What is ataxic telangiectasia?
It is a complex multi system disorder characterised by progressive neurological impairment, cerebellar ataxia, immunodeficiency, impaired organ maturation, ocular and skin telangiectasia and predisposition to malignancy.

Paediatrics (13 decks)

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