Neurology

Question 1

What is botox used for in the treatment of cerebral palsy?

Answer 1

To relax tendons and decrease hypertonia

Question 2

What is cerebral palsy?

Answer 2

A group of non-progressive, but often changing, motor impairment syndromes secondary to lesions or anomalies of the brain arising in early stages of development.

Question 3

What causes cerebral palsy?

Answer 3

Prenatal disturbance of brain cell migration (genetic or environmental)
Prenatal poor myelination (insulation) of developing nerve cell fibers.
Perinatal brain cell death (e.g. in hypoxia)
Postnatal non-functional or inappropriate synapses between brain cells – (trauma, infections, and asphyxia)

Question 4

What are the antenatal preventable causes of CP?

Answer 4

Maternal infection
Periventricular leukomalacia (occurs in prematurity)

Question 5

What is the main intrapartum cause of CP?

Answer 5

Asphyxia

Question 6

What are the postnatal preventable causes of CP?

Answer 6

Infection
Kernicterus
Hydrocephalus

Question 7

What are the 3 types of CP?

Answer 7

1. Spastic quadriplegia
2. Spastic diplegia
3. Choreoathetoid (associated with kernicterus)

Question 8

What is grade IV IVH also known as?

Answer 8

Intraventricular venous infarction

Question 9

What are the 3 main life-long complications of IVH?

Answer 9

1. Seizures
2. Developmental delay
3. Cerebral palsy

Question 10

When IVH is associated with trauma or asphyxia where does the bleeding usually occur?

Answer 10

Choroid plexus

Question 11

What are the two most important risk factors for grade IV haemorrhage?

Answer 11

1. Prematurity

2. Low birth weight

Question 12

What are the common presenting symptoms of IVH?

Answer 12

Diminished/absent moro reflex
Poor muscle tone
Sleepiness
Lethargy
Apnoea

Question 13

What is the diagnostic tool of choice for IVH?

Answer 13

Transfontanelle ultrasound

Question 14

What are the preventative measures used for IVH?

Answer 14

Mother given steroids.
Infant given indometacin
Vitamin K given to all newborns
Timing of delivery to reduce chance of asphyxia.

Question 15

What pharmacological treatments are used in IVH?

Answer 15

Anticonvulsants for seizures.

Acetazolamide for CSF production reduction.

Question 16

What surgical interventions may be used for IVH?

Answer 16

Shunts.
Serial LPs (controversial)

Question 17

What are the features of a febrile convulsion?

Answer 17

Absence of other cause and not due to intracranial infection.
Occurs between 6m and 6y.
Occurs early in viral infection as temp increases.
Seizures last

Question 18

What % of those with febrile convulsions go on to develop epilepsy?

Answer 18

1%

Question 19

How do we manage febrile convulsions?

Answer 19

Give parents advice on anti-pyretic measures (calpol, methods of reducing temperature).
Admit children with first febrile convulsion if bed space, as parents worry.
Have a low threshold for suspecting meningitis.