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Neurology Flashcards

1
Q

What are the different types of seizures?

A
  • Generalised tonic clonic
  • Focal seizures - mainly temporal lobe
  • Absence seizures
  • Atonic seizures - drop attacks
  • Myoclonic seizures
  • Infantile spasms
  • Febrile convulsions
  • Benign rolandic seizures
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2
Q

Generalised tonic clonic seizure:
- CF
- Treatment

A

CF - loss of conc, muscle tensing and then jerking movements, tongue biting, incontinence, irreg breathing, post ictal period
1st line - Na valproate
2nd line - lamotrigine or carbamazepine

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3
Q

Focal seizures:
CF
Treatment

A

CF - most commonly temporal lobes, hallucinations, memory flashbacks, deja vu
1st line - carbamazepine or lamotrigine
2nd line - Na valproate, levetiracetam

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4
Q

Absence seizures:
- CF
- Treat

A

CF - children, pt blank and stares into space and then back to normal, unresponsive, sec long
1st line - Na valproate or ethosuximide

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5
Q

Atonic seizures:
- CF
- Treat

A

Drop attacks = brief lapses in muscle tone, ~3mins.
1st line - Na valproate
2nd line - lamotrigine

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6
Q

Myoclonic seizures:
- CF
- Treat

A

CF - sudden brief muscle contractions, pt conc
1st line - Na valproate
2nd line - lamotrigine, levetiracetam, topiramate

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7
Q

What are infantile spasms? How are they treated?

A

Infantile spasms/West syndrome - clusters of full body spasms, poor prognosis.
1/3 die by 25, 1/3 seizure free.
Treat - pred and vigabatrin

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8
Q

What are the ix into childhood epilepsy?

A
  • Hx, pt allowed one seizure before being ix for epilepsy
  • EEG
  • MRI brain to rule out structural problem
  • ECG
  • Bloods - electrolytes, hypoglycaemia, cultures
  • LP and urine cultures if suspect sepsis, encephalitis or meningitis
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9
Q

How do you manage a pt having a seizure?

A

Safe position, recovery if possible w something soft under head
Remove any obstacles
Start timer
Call ambulance if >5 mins

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10
Q

SE of Na Valproate

A

Teratogenic
Hepatitis
Hair loss
Tremor

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11
Q

SE of carbamazepine

A

Agranulocyotosis
Aplastic anaemia

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12
Q

SE of phenyotin

A

Folate def - megaloblastic anaemia
Vit d def - osteomalacia

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13
Q

SE of ethosuximide

A

Night terrors and rashes

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14
Q

SE of lamotrigine

A

Steven Johnson syndrome
Leukopenia

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15
Q

What is muscular dystrophy?

A

Muscles break down and become weaker over time - most commonly called Duchenne muscular dystrophy.
Caused by mutations = no dystrophin, X linked recessive so mainly in males w females being carriers.

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16
Q

What is the presentation of Duchenne’s muscular dystrophy?

A
  • Muscle wasting and weakness in early childhood
  • Wheelchair bound before puberty and die from resp failure by early twenties
  • Bulky muscles eg. calves - muscle replaced by fat
  • Child slips through their hands - loose muscles in shoulder
  • Gower’s sign - walk their arms up their legs when getting up = proximal muscle weakness
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17
Q

How is Duchenne’s muscular dystrophy diagnosed?

A

Genetic testing is gold standard, used to be muscle biopsy
CK as first line test to screen for muscular dystrophy

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18
Q

What is the management of muscular dystrophy?

A

No cure, just giving person highest QOL for longest time possible. Oral steroids and creatine supplementation can reduce progression by a few years.
Duchenne - die in twenties
Becker’s - die in thirties

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19
Q

What is spinal muscular atrophy? What are the types?

A

Autosomal recessive progressive loss of motor neurones = progressive muscular weakness. Affects LMN in spinal cord.
SMA type 1 - onset in first few months, death w/i 2 years
SMA type 2 - onset w/i first 18 months, never walk but survive into adulthood
SMA type 3 - onset after first year of life, walk but then loose ability, normal life expectancy
SMA type 4 - onset 20s, ability to walk short distances, significant fatigue

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20
Q

What are the neuro signs of SMA?

A

LMN signs:
- Fasciculations
- Atrophy
- Hypotonia
- Weakness
- Reduced or absent reflexes

21
Q

What is the management of SMA?

A
  • No cure
  • PT to maximise strength or muscles and resp func
  • Splints, braces, wheelchair
  • NIV resp support, esp when sleeping
  • Tracheo and mechanical ventilation in SMA type 1
  • PEG needed if unsafe swallow
22
Q

What are breath holding spells and what are the types?

A

Involuntary episode of holding breath when triggered by something upsetting or scary at ~6-18m.
1. Cyanotic breath holding spells
2. Pallid breath holding spells/reflex anoxic seizures

23
Q

What are cyanotic breath holding spells?

A

Upset, crying child - let out long cry, stop breathing = cyanotic and unconc.
W/i a minute they regain conc and start breathing, will be a bit tired and lethargic after episode.

24
Q

What are reflex anoxic seizures?

A

Child is startled = vagus nerve sends signals to heart to stop it beating = suddenly pale, LOC and then seizure twitching, w/i 30 secs heart restarts and child conc again.

25
What is craniosynostosis?
Skull sutures close prematurely = abnormal head shapes and restriction of brain growth = raised ICP = develop delay, cog impairment, vom, visual impair, neuro sx and seizures
26
What are the ix into craniosynostosis? What is the management?
Skull XR, CT head if doubt Manage - severe = surgical reconstruction
27
What are some differentials for headache in children?
Tension headache Migraine ENT infection/URTI Analgesic over use headache Visual issues Raised ICP Brain tumours Meningitis and encephalitis CO poisoning
28
What is the management of migraine in children?
- Rest, fluids, dark room - Paracetamol and ibuprofen - Sumatriptan - Antiemetics - prochlorperazine, cyclizine Prophylaxis - propanolol (not in asthma), pizotifen, topiramate
29
What is normal CSF physiology?
x4 ventricles - x2 lateral, and a third and fourth ventricle, all contain CSF which is make in choroid plexuses. Arachnoid granulations collect CSF and absorb it into venous system.
30
What are some causes of hydrocephalus?
Hydrocephalus = excess CSF: - Aqueductal stenosis - prob w drainage - most common cause - Arachnoid cysts can block outflow of CSF - Chromosomal abnorm and congenital malformations can cause obstruction
31
What are the CF and signs of hydrocephalus?
- Enlarged and increasing occipito frontal circumferance - Bulging ant fontanelle - Poor feeding and vom - Poor tone - Sleepiness
32
What is the management of hydrocephalus?
VP shunt - normally drains CSF into peritoneal cavity where it will be absorbed
33
What are the complications of VP shunt?
Infection Blockage Excessive drainage IV haemorrhage Outgrowth - need to be replaced every 2 years as child grows
34
What are some causes of raised ICP in children?
- Brain tumour - Hydrocephalus - Intracranial infection -
35
What are the signs of a sloppy child?
- Infant slides through hands when held upright under arms - Flops like a rag doll - When pulling up to sit there is head lag
36
Central vs peripheral hypotonia?
Central - global hypotonia, have antigravity movements, poor truncal tone but normal limb tone, brisk tendon reflexes Peripheral - global hypotonia, weak or absent antigravity movements, reduced tendon reflexes
37
What are some causes of floppy infant?
- HIE - Intracranial haemorrhage - Hypothyroid - Metabolic errors - Trisomy 21, Prader Willi syndrome - dysmorphic features - Spinal cord injury - Neonatal myasthenia gravis - Myotonic dystropy
38
What causes extradural haemorrhage and what are the CF?
Cause - direct head trauma, middle meningeal artery bleeds CF - lucid interval and then reduced conc, +/- epilepsy, can have dilation of ipsilateral pupil, other CN palsies
39
What is the management of extradural haemorrhage?
IV fluid resus Evacuation of haematoma and arrest bleeding
40
What causes subdural haematoma?
Tearing of bridging veins as they cross subdural space - non accidental injury !!!!! shaking and direct trauma in infants and toddlers. Have retinal haemorrhages also if shaking.
41
What are the features of SAH in children?
Really not v common - more in adults. Thunderclap headache, seizure, reduced conc, coma, vom. CT scan +/- LP, usually caused by aneurysm or malformation of blood vessels. Treat = neurosurg or interventional radiology
42
What are the CF of neurofibromatosis T1?
- Cafe au lait - Neurofibroma - Optic glioma = visual impairment - FH - Axillary freckling - Can give ADHD
43
What is spina bifida?
Neural tube defect = incomplete develop of spinal column = herniation of spinal cord
44
What are the different types of spina bifida?
Spina bifida occulta - incomplete fusion of vertebrae but no herniation of spinal cord, small tuft of hair overlying site Meningocele - incomplete fusion of vertebrae w meningeal sac herniation, just contains CSF Myelomeningocele - incomplete fusion of vertebrae w herniation of meningeal sac containing CSK and spinal cord, other defects
45
What are the associations of myelomeningocele?
- Variable paresis of lower limbs w hypotonia - Muscle imbalance - Sensory loss - Bladder and bowel denervation - Scoliosis - Hydrocephalus Manage all in management
46
What features associated w headache suggest SOL?
- Visual field defects - CN palsy - Abnormal gait - Growth failure - Cranial bruits - Early or late puberty - Papilloedema - Change in personality Red flags - headache worse w lying down or coughing, wakes child. up in night, early morning vom, change in personality or beaviour
47
What are some SE of pizotifen?
- Is a tricyclic so fatal in overdose - Weight gain and sleepiness
48
What is benign rolandic epilepsy?
Seizures at night - focal = unilateral face and upper limb motor sx w no LOC

Paediatrics (15 decks)

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