neurology Flashcards
what is a febrile fit?
seizure in presence of fever
age of febrile fit
6 months to 6 years of age
causes of febrile fit
immature brain more susceptible to environmental changes/factors
what increases risk feb fit
fam history 1/4 will have one
can be secondary to
febf it
uti, urti, gastroenteritis
otitis media
etc
does feb fit increasee risk of epilepsy
nuh uh bruh
when does fever occur with feb fit
usually precedes convulsions
how long does convulsion tend to last
with feb fit
3-6 minutes
tend to occur once in 24 hr
how does convulsion present with feb fit
twitching of the face arms legs eye rolling stifness jerking loss of consciousness
generalised tonic clonic
what do you need to rule out when child comes in with query feb fit
any serious causes such as meningitis and encephalitis
What can increase seizure risk with febrile fits
if > 20 minutes
family hx
what type of seizure is febrile fit
temporal lobe
when do you need to do a hospital assessment
with feb fit
<18 months
first seizure or was not assessed after first seizure
serious cause
parental anxiety
There is diagnostic uncertainty about the cause of the seizure.
There were any of the following features:
The seizure lasted for more than 15 minutes, or
There were focal features during the seizure, or
recurred in the same febrile illness, or within 24 hours, or
incomplete recovery after one hour.
The child has no serious clinical findings but is currently taking antibiotics or has recently been taking them.
management of feb fit
ABCDE recovering position infer over >5-10mins MIDAZOLAM infection source find if suspecting mengitis do LP
advice to parents of feb fit
reasurrance protect head do not restrain or put anything in mouth remove nearby danger very common high temp causes it- no longstanding brain damage not same as epilepsy and doesn't increase risk -very mariginaly different antipyrexical don't help 1-3 another episode
acute management if happens again-undress. give paracetamol, fluid intake, fan
< 5 mins seek help
When the seizure stops, check their airway and place them in the recovery position.
If the seizure lasts more than 5 minutes give:
Rectal diazepam repeated once after 5 minutes if the seizure has not stopped, or
One dose of buccal midazolam.
doses of rectal diazepam
ecommended doses of rectal diazepam (repeated after 5 minutes if necessary) are:
Less than 1 month of age: 1.25–2.5 mg.
1 month–1 year of age: 5 mg.
2–11 years of age: 5–10 mg.
mizadolam doses
Midazolam may be given as a single dose by the buccal route (intravenous solution for injection should be administered into the buccal cavity between the gum and cheeks using a syringe or straw), although it is not licensed for this indication. Recommended doses of midazolam are:
Less than 6 months of age: 300 micrograms/kg body weight (maximum 2.5 mg).
6 months–11 months of age: 2.5 mg.
1–4 years of age: 5 mg.
5–9 years of age: 7.5 mg.
when to call ambulance with feb fit
all an emergency ambulance if, 10 minutes after the first dose:
The seizure has not stopped.
The child has ongoing twitching (although the larger jerking movements have stopped).
Another seizure has begun before the child regains consciousness.
Measure blood glucose if the child cannot be roused or is convulsing.
nice guidelines about parental advice with feb fit
Inform parents about the nature of febrile seizures:
Febrile seizures are not the same as epilepsy. The risk of epilepsy developing later is low but slightly higher than the general population.
Short-lasting seizures are not harmful to the child.
About 1 in 3 children will have another febrile seizure.
Advise parents on what to do if a further seizure occurs. They should:
Protect them from injury during the seizure.
Not restrain them or put anything in their mouth.
Check their airway and place them in the recovery position when the seizure stops. Explain that the child may be sleepy for up to an hour after the seizure.
Seek medical advice if a seizure lasts for less than 5 minutes, or call an ambulance if the seizure continues for more than 5 minutes.
Advise parents about managing fever, but explain that reducing fever does not prevent recurrence. Advice should cover:
When and how to use ibuprofen and paracetamol to reduce fever.
Practical measures on how to reduce fever and prevent dehydration.
When to seek medical help because of prolonged symptoms, or deterioration, especially if there are features of a serious underlying cause for the infection, such as meningitis.
For further information see the CKS topic on Feverish children - management.
Advise parents to continue childhood immunizations even if the febrile seizure followed an immunization.
Do not prescribe drugs to manage or prevent future seizures unless advised to do so by a specialist. This may be advised following assessment of a child with an indication for urgent admission.
Arrange follow-up, the timing of which will depend on the clinical condition of the child.
what is a breath holding attack
how long
infant usually or toddler is upset angry or scared they tend to be trigged by trauma or anger can be caynatoic appear to stop breathing on exhalation its involuntary lasts less than. 1min
episodes include
BHA
prolonged crying and bread held can lead to cynaosis
grow out by 5 years usually 6 to 18months
F=M
two types of BHA
cyanotic and pallid spells
describe each bHA
cyanotic preceipated by crying very upset deep breath cyanotic limb extend may be stiff or floppy cn become unconscious for less than a min involuntary not dangerous breathing resumes after a gasp
what Does it increase risk of later on with BHA
vasovagal attacks
what about pallid spells
a reflex anoxic seizure
6months -2years
no epielspetic
mostly due to shock or pain or sudden fright
triggers including minor injury and bump on head
more of a vagal reflex
overactivity transient bradycardia and circulatory imapriement
may or may not cry
turn pale and collapse
stiff>floppy
less Lilkely to cry
gasp as they come around
traient apnoea and limpness may look grey
grow out of
place in recovery position
pale limp unconscious –> tonic clonic phase
30-60seconds
management of breath holding attacks
eeg reassurance to parents stay calm lie child on side wartch avoid shaking don't put anything in mouth don't splash with water rest child don't punish or reward see gp and have leg after first episode esp if under 6 months or if frequent, confusion of lasting more than a min
important thing to rule out with BHA
iron deficiency
how many cases of epilepsy in uk
600,000
what is epilepsy
inappropriate signalling sensory and monitor activity is abnormal - causing activity to be disorder
can be caused be infection fever syncope space occupying lesions
in lay man terms epilepsy
signals travel from brain to all parts of body in order to carry out activities and function
in epilepsy these signals are jumbled
causes repeated bursts of electrical activity in the brain
symptoms include:uncontrollable jerking and shaking – called a “fit”
losing awareness and staring blankly into space
becoming stiff
strange sensations – such as a “rising” feeling in the tummy, unusual smells or tastes, and a tingling feeling in your arms or legs
collapsing
two categories of epilepsy
focal: locales part of brain (frontal, temporal)< usually no loss of consciousness
generalised: both hemisphere involved - atonic, tonic, myoclonic, etc
management acute setting
three crucial things.
0-5 mins
0-5 mins, ABCDE
check glucose IV access
what if it lasts >5 mins seizure
5-15mins
same bt also LORAZEPAM
or midazlam If no iV access
what if it lasts >25 mins seizure
phenytoin or phenarbital
if not iv access paraldehyde
and over 45 mins seizur
PICU and consider putting to alesp with thiopental whilst ventilated and wean slowly
RARE
things to cover in history
seizure
what happened before during and after witness EEG done before video telemetry MRI advice- do not lock bathroom door at home, shower > bath helmet when cycling tell lifeguard when sweimming driving-need to be fit free
sepsis mx
LP
BUFALO
general cephalosporins
Xray
what is infantile spasm
-repeated flexion of trunk forceful and throws arm up less steady on feet can draw or use cutlery half outgrow, half have pathology may have future seizure or DD
what would EEG show for infantile spasms
synchronous spikes
west syndrome
350-400 in uk severe epilepsy syndrome triad of: 1. infantile spasms 2. hypsarrthmia mental retardaation
eeg patterns
within first year
attacks-> brief and infrequent
treatment of infantile spasms and west syndrome
IS; vigabrain, steroid, acth (3)
WS: VIAGBARITIN , COTISOCETIODS, MITRAZPAM, NA VALPORATE (4)
what is spina bifida?
neural tube defect
how does it occur spina bifid a
failure of neural tube to close in pregnancy
symptoms of spina bifida
lemon shaped skull (Arnold chiari malformation)
tuft of hair on lower back
weakness or total paralysis of the legs
bowel incontinence and urinary incontinence
loss of skin sensation in the legs and around the bottom – the child is unable to feel hot or cold, which can lead to accidental injury
Many babies will have or develop hydrocephalus (a build-up of fluid on the brain), which can further damage the brain.
Most people with spina bifida have normal intelligence, but some have learning difficulties.
risk factor for spina bifida
folic acid deficiency in pregnancy
fhx
diagnosis
tected during the mid-pregnancy anomaly scan, which is offered to all pregnant women between 18 and 21 weeks of pregnancy.
treatment of spina bifida
surgery soon after birth to close the opening in the spine and treat hydrocephalus
therapies to help make day-to-day life easier and improve independence, such as physiotherapy and occupational therapy
assistive devices and mobility equipment, such as a wheelchair, or walking aids
treatments for bowel and urinary problems
what is muscular dystrophy
x linked autoressive condition causing abnormality to dystrophin protein
how does it present muscular dystrophy
motor milestone delay and sometimes mild speech delay
progressive condition
