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Neurology Flashcards

(54 cards)

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1
Q

How does brain develop

A

Myelin sheath

Synapses between dendrites

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2
Q

What can affect the brain

A 
Congenital
Neurogenetic
Neurometabolic
Infection
Ischaemia 
Trauma
Tumour 
Autoimmune
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3
Q

What do you look for in neuro examination (difficult to do full adult in young child)

A 
Observation 
Appearance / unusual facial features / skin findings 
Gait
Posture 
Head circumference
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4
Q

What is the most common cancer in children and 2nd most common

A

Leukaemia

Brain tumour

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5
Q

What can you describe headaches as

X = underlying cause more likely

A

Isolated acute X
Recurrent acute
Chronic progressive X = worry
Chronic non-progressive

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6
Q

What type of headache is migraine

A

Acute and recurrent = most common type

Tension = second most common

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7
Q

What do you include in headache history

A 
Is there more than one type of headache
Any warning signs 
Location
Severity
Duration 
Frequency
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8
Q

What is a red flag sign in headache

A

Localised to the back

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9
Q

What do you look for on examination of headache and what does this indicate

A 
Growth - craniopharyngioma
OFC - hydrocephalus 
BP - hypertension 
Sinuses - sinusitis 
Visual acuity - vision headache
Fundoscopy - papilloedema 
Visual field - craniopharyngioma 
Cranial bruit
Focal neurological signs
Cognitive / emotion
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10
Q

How many tension type headaches do you get and how long do they last

A

10+

30 mins- 7 days

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11
Q

What are tension headahce

A 
Diffuse and symmetrical
Bilateral 
Band like 
Present most of the time
Constant mild ache 
No N+V / photo or phonophobia / no aggravation exercise
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12
Q

What suggests raised ICP (need scan)

A

Worsen bending down / coughing / straining
Woken up from sleep
Morning headache
Vomiting

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13
Q

What suggests analgesic overuse

A

Headache is back before allowed to use another dose

Common in paracetamol, NSAIDs, cocodamol

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14
Q

What are indications for neuroimaging

A 
Cerebellar dysfunction
Features of raised ICP
New focal neurological deficit e.g. squint 
Seizures esp focal
Personality change 
Unexplained deterioration of school work
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15
Q

What are features of cerebellar dysfunction

A 
Dyskinesia
Ataxia
Nystagmus
Inentention tremor
Scanning dysarthria
Hypotonia 
Past pointing on finger nose test
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16
Q

How do you manage TTH

A

Reassure no sinister cause
MDT
Look for physical / psychological causes
Analgesia - paracetamol 15mg /kg or Ibuprofen 10mg / kg

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17
Q

What do you give as prophylaxis

A

Amitryptilline

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18
Q

Most common type of headache in children

A

Migraine

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19
Q

How many migraine can you get

A

5+

4-72 hours

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20
Q

How does migraine present

A 
Hemicranial 
Uni or bilateral
Frontal or temporal
Throbbing or pulsatile 
Abdo pain
N+V
Pallor
Photophobia
Focal - visual / parathesia / weakness / aura
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21
Q

What triggers migraine

A

Fatigue
Stress
Exercise
FH

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22
Q

What relieves migraine

23
Q

What do you give acutely

Study These Flashcards
A

Triptans >12 nasal spray

Ibuprofen

24
Q

How do you prevent migraine

Study These Flashcards
A

Propranolol = 1st line
Amitryptiline
Sodium valproate

25
What is the role of the EEG
EEG if not having a seizure is not sensitive (30-60%) May have false +ve findings on EEG Useful if catch during a seizure Useful to find out seizure type, syndrome and cause rather than Dx
26
What is cerebral palsy
Non-progessive lesion of motor pathway in developing brain | More at risk if pre-term
27
What causes
``` Antenatal - Rubella / toxoplasmosis / CMV Bith asphyxia Pre-term IVH Meningitis Severe jaundice Head injury / trauma ```
28
What types of cerebral palsy
Spastic due to damage to UMN Dyskinetic due to damage to basal ganglia Ataxic due to damage to cerebellum
29
How does cerebral palsy present
``` Hypertonia Clonus Brisk reflex LImb weakness Spastic Delayed motor Abnormal gait Poor feeding ```
30
How do you treat cerebral palsy
``` MDT Physio OT SALT - may need NG or PEG Dietician Orthopaedic surgeon Spasticity - baclofen / diazepam / botox Anti-convulsant for epilepsy Analgesia ```
31
Complications
``` LD Epilepsy Squint Hearing and visual GORD Muscle contractures ```
32
Most common cause of death in children
Head injury
33
Indications for ED / observation
``` GCS <15 Post trauma seizure Focal neuro Fracture sign LOC Severe + persistent headache Repeat vomit >1 Amnesia >5 Retrograde >3 High risk mechanism Coagulopathy ```
34
How do you examine
``` AVPU GCS Pupils Vital signs Palpate skull Battle sign Examine TM - CSF / blood in ears Temp / blood glucose - other causes of seizure / LOC ```
35
Indications for immediate head CT
``` GCS <13/14 or 15 if <1 Basal skull HIgh speed RTA LOC >30 mins Focal neuro Open or depressed skull or tense fontanelle Coagulopathy ```
36
Head CT within 8 hours
``` Bruising Laceration >5cm Amnesia >5 minutes + retrograde >3 Seizure Repeated vomitng >1 Drowsy within 8 hours NAI ```
37
How do you image C-spine
X-ray <10 | CT >10
38
When do you image C-spine
Severe head or cord injury signs e.g. weakness
39
When do you admit to the ward
``` CT needed NAI Co-morbid Can't make full assessment Social ```
40
When do you discharge with follow up
``` Consciousness recovered E+D No vomit Neuro resolved Imaging reviewed ```
41
What is hydrocephalus
Impaired cerebrospinal flow | Resorption or eccess production
42
What causes hydrocephalus
Most commonly genetically acquired outflow obstruction at cerebral aqueduct Aqueductal stenosis that connects 3rd and 4th ventricle Arachnoid cyst Arnold chair
43
What are the clinical features of hydrocephalus
``` Increase in head circumgerence Bulding anterior fontanelle Vomiting Droswy Irritbale Poor tone Sunsetting eyes - downward Seizures Blurred vision Headaches ```
44
How do you treat hydrocephalus and complications
VP shunt Infection Blockage IVH during surgery Return of Sx due to outgrowing
45
What is common cause of neonatal death
Hypoglycaemia Meningitis Head trauma
46
What suggests basal skull fracture
Battle sign Panda eyes Blood or CSF out of ear or nose
47
What is important in the history of head injury
``` Mechanism LOC Vomiting Headache VIsual Drowsy Were they well prior ```
48
What should you do if sending home
Safety net worsening symptoms
49
What is craniosyntosis and complications
``` Skull sutures close prematurely resulting in abnormal head shape Small in proportion to body Will eventually lead to raised ICP Developmental delay Cognitive impairment Vomiting Irritable Visual Seizure ```
50
How do you Dx
Refer specialist Skull X-ray = 1st line CT to confrim
51
How do you Rx
Surgical reconstruction
52
What is other causes of abnormal head
Plagiocephaly | Brachycecphaly
53
What causes
Babies resting head at particular point | Results in bone and sutures moulding
54
How do you manage
Exclude craniosyntosis Reassurance Supervised tummy time

Paediatrics (35 decks)

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