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Neurology Flashcards

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1
Q

Causes of syncope?

A

primary:
dehydration
missed meals
extended standing
vasovagal response to stimuli

secondary:
hypoglycaemia
dehydration
anaemia
infection
anaphylaxis
arrhythmias
valvular heart disease
HOCM

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2
Q

Syncope vs seziure?

A

Syncope:
prolonged upright position
light-headedness prior
sweating prior
blurring of vision prior
reduced tone
return of consciousness shortly after falling
no prolonged post-ictal period

Seizure:
epilepsy aura
head turning or abnormal limb positions
tonic clonic activity
tongue biting
incontinence
cyanosis
>5 mins
prolonged post-ictal period

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3
Q

Investigations for syncope?

A

Hx and Exam
lying and standing BP
ECG
Holter
Echo
Bloods (FBC, electrolytes, glucose)

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4
Q

Mx of primary syncope?

A

reassurance
advice on what to do if feeling faint
avoid dehydration, prolonged standing, missing meals

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5
Q

What is epilepsy?

A

epilepsy refers to conditions in which the patient is prone to having seizures, which are caused by abnormal electrical activity within the brain

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6
Q

Types of seizures?

A

generalised tonic-clonic seizure
focal seizure
absence seizure
atonic seizure
myoclonic seizure
infantile spasms (West Syndrome)
febrile convulsions

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7
Q

What are generalised tonic-clonic seizures?

A

typical seizure
LOC + muscle tensing and muscle jerking movements
may be tongue biting, incontinence, groaning, irregular breathing
post-ictal period

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8
Q

Mx of generalised tonic-clonic epilepsy?

A

first-line - sodium valproate, lamotrigine, levetiracetam

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9
Q

Mx of focal seizures?

A

lamotrigine, levetiracetam

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10
Q

Mx of myoclonic seziures?

A

sodium valproate, levetiracetam

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11
Q

Mx of tonic and atonic seizures?

A

sodium valproate, lamotrigine

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12
Q

Mx of absence seizures?

A

ethosuximide

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13
Q

What are focal seizures?

A

seizures that start in the temporal lobe, thus affecting speech, hearing, memory and emotions
hallucinations
flashbacks
deja vu
doing strange things on autopilot (automatism)

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14
Q

What are absence seizures?

A

typically only affect children, who grow out of them
unaware of their environment and non-responsive

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15
Q

What are atonic seizures?

A

‘drop attacks’
may be indicative of Lennox-Gastaut syndrome

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16
Q

What are myoclonic seizures?

A

jerking of muscles but child remains conscious for it
occur in juvenile myoclonic epilepsy

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17
Q

What are infantile spasms?

A

aka West Syndrome
starts at around 6 months
characterised by clusters of full body spasms with upset in between
developmental regression
poor prognosis - 1/3 die before 25, 1/3 are seizure free by 25

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18
Q

What are febrile convulsions?

A

seizures that occur in children when they have a fever
6 months - 6 years
recur but only a slight incr. risk of developing epilepsy

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19
Q

Mx of infantile spasms?

A

prednisolone
vigabatrin

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20
Q

EEG results in infantile spasms?

A

hypsarrhythmia

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21
Q

Investigations for epilepsy?

A

Hx and Exam
start investigations after second simple seizure
EEG
MRI brain

ECG
blood electrolytes
blood glucose
blood, urine cultures, LP

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22
Q

General advice in epilepsy?

A

education!!!!
showers > baths
avoid swimming
be cautious with heights
be cautious with traffic
be cautious with heavy equipment
be cautious with hot things
driving

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23
Q

Simple vs Complex Febrile convulsions?

A

simple - generalised tonic, clonic seizures lasting less than 15 minutes with good recovery and only occurring once during a febrile illness

complex - partial or focal seizures, last more than 15 minutes, occurring multiple times during the same illness, not recovering in between episodes

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24
Q

DDx of febrile convulsions?

A

epilepsy
meningitis
encephalitis
SOL (tumour, haemorrhage)
syncopal episode
electrolyte abnormalities
trauma (NAI)

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25
Mx of febrile convulsions?
identify and treat underlying infection anti-pyretic reassurance if simple and advice further investigations if complex Advice: stay with child safe place recovery position don't put anything in their mouth call an ambulance if >5 mins
26
Prognosis of febrile convulsions?
1/3 have further febrile convulsion 1.8% risk of epilepsy in general population 2-5% risk after simple febrile convulsions 10-20% after complex febrile convulsions
27
What are breath holding spells?
involuntary episodes affecting children between 6-18 months where they hold their breaths after an upsetting stimulus
28
2 types of breath holding spells?
cyanotic breath holding spells reflex anoxic seizures
29
Causes of headache in children?
tension headache migraine ENT analgesic headache vision problems raised ICP brain tumours meningitis encephalitis carbon monoxide poisoning
30
Triggers for tension headaches in children?
stress, fear, discomfort skipping meals dehydration infection
31
Mx of tension headaches?
reassurance analgesia regular meals avoiding dehydration underlying stress
32
Types of migraine?
migraine with aura migraine without aura silent migraine hemiplegic migraine abdominal migraine (v common in children)
33
Symptoms of migraine?
unilateral headache photophobia phonophobia visual aura nausea and vomiting anorexia abdominal pain
34
Mx of migraine?
rest, fluids, low stimulus environment paracetamol ibuprofen sumatriptan antiemetics If impacting QOL, prophylaxis: propranolol pizotifen topiramate (not in child-bearing age)
35
What is cerebral palsy?
condition characterised by the permanent neurological problems resulting from damage to the brain at the time of birth not progressive, however may present differently at times due to different stages of development huge variation in presentations
36
Causes of cerebral palsy?
antenatal: maternal infections trauma during pregnancy perinatal: birth asphyxia pre-term post-natal: meningitis severe neonatal jaundice head injury
37
Types of cerebral palsy?
spastic (pyramidal) dyskinetic (extrapyramidal, athetoid) ataxic mixed
38
How does spastic cerebral palsy present?
hypertonia and reduced muscle function due to damage to UMNs
39
How does dyskinetic cerebral palsy present?
problems controlling tone, causing athetoid and oro-motor problems due to damage to the basal ganglia
40
How does ataxic cerebral palsy present?
problems with coordinated movements due to damage to the cerebellum
41
Patterns of spastic cerebral palsy?
monoplegia diplegia hemiplegia quadriplegia
42
Presentation of CP?
difficult to predict from birth injury -> follow-up needed failure to meet milestones incr. or decr. tone hand preference before 18 months problems with coordination, speech or walking feeding or swallowing problems learning difficulties
43
Complications of CP?
learning disability epilepsy kyphoscoliosis muscle contractures hearing and visual difficulties GOR
44
Mx of CP?
MDT approach, link with the disability network physio OT SALT dietician (may require NG or PEG) orthopaedic surgeons paediatricians social worker support groups
45
Medical Mx of CP?
muscle relaxants (baclofen) for spasticity or contractions anti-epileptics glycopyrronium bromide (drooling)
46
Causes of strabismus?
usually idiopathic hydrocephalus CP SOL e.g., retinoblastoma trauma
47
Mx of strabismus?
don't delay treatment, visual fields are still developing up till 8 occlusive patch or atropine drops in good eye coordinated by ophthalmologist and correct any refractive errors
48
What is a hydrocephalus?
when CSF builds up abnormally within the brain and the spinal cord either caused by an overproduction of CSF or a problem with the drainage or absorption
49
Congenital causes of hydrocephalus?
aqueductal stenosis arachnoid cysts Arnold-Chiari malformation chromosomal abnormalities congenital malformations can cause obstruction to drainage
50
What is Arnold-Chiari malformation?
where the cerebellum herniates down through the foramen magnum, blocking the flow of CSF
51
Presentation of hydrocephalus?
enlarged and increasing OFC bulging anterior fontanelle poor feeding and vomiting poor tone sleepiness
52
Mx of hydrocephalus?
insertion of a ventriculoperitoneal shunt
53
Complications of VP shunts?
infection blockage excessive drainage IVH during shunt surgery outgrowing them (need replacement every 2 yrs)
54
What is craniosynostosis?
occurs when skull sutures close prematurely, leading to abnormal skull shapes and restriction of the brain, causing raised ICP
55
Presentation of craniosynostosis?
abnormal head shape, depending on which suture is affected anterior fontanelle closing before 12 months small head in proportion to body
56
Shape of skull depending on affected suture?
sagittal suture -> long and narrow from front to back coronal suture -> bulging on one side of forehead metopic suture -> pointy triangular forehead lambdoid suture -> flattening on one side of the occiput
57
Mx of craniosynostosis?
skull X ray CT head watch and wait if severe -> Sx reconstruction good prognosis
58
What is plagiocephaly?
flattening of one area of the baby's head brachycephaly -> flattening of the back of the baby's head
59
Why is plagiocephaly more common?
baby's sleeping on their back -> SIDS
60
Mx of plagiocephaly?
exclude craniosyntosis exclude torticollis reassurance position on the other side tummy time supervised minimising time in push chairs ?plagiocephaly helmets
61
What is muscular dystrophy?
an umbrella term for a group of genetic conditions that cause gradual weakness and wasting of muscles
62
Types of muscular dystrophy?
Duchenne muscular dystrophy Becker muscular dystrophy myotonic dystrophy
63
What is Gower's sign?
due to proximal muscle weakness, use their hands to stand up and climb up their legs
64
Mx of muscular dystrophy?
no curative treatment aim is to give highest QOL for highest amount of time MDT OT, physio, medical appliances manage complications such as scoliosis and heart failure
65
Inheritance pattern of Duchenne muscular dystrophy?
X-linked recessive dystrophin gene affected
66
Presentation of Duchenne muscular dystrophy?
boys 3-5yrs weakness in muscles around pelvis initially spreads to all muscles usually wheelchair bound by teenage years life expectancy 25-35 yrs
67
What is spinal muscular atrophy?
rare autosomal recessive condition that causes a progressive loss of lower motor neurones in the spinal cord, causing progressive muscular weakness
68
Categories of SMA?
1-4, most - least severe 2 most common (onset within 18 months, most never walk but survive into adulthood)
69
Mx of SMA?
no curative treatment MDT physio medical appliances respiratory support PEG feeding

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