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Paediatrics > Neurology > Flashcards

Neurology Flashcards

1
Q

Define Migraine

A

Recurrent headaches with or without aura that last (in children) from 30 minutes to 48 hours

Most common cause of primary headache in children

Commonly bilateral in children (this is not the case in adults)

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2
Q

Classification

A

With Aura = Classical Migraine

Without Aura = Common migraine

Hemiplegic = Hemipleagia may precede or accompany a less dramatic headache

Basilar Migraine = Aura often followed by dizzined syncope and MINIMAL headache - adolescent girls m/c

Opthalmoplegic Migraine = Disorders of eye movement or pupillary response precede the headache

Acute confusional Migraine = migraine before or following an episode of transient amnesia, confusion or expressive aphasia –> Follows minor head trauma

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3
Q

Mx of Migraine

A

Conservative management alone is often most effective
Lifestyle Trigger - Stress, food, sleep
Simple analgesia - Paracetamol, NSAIDs
Anti-emetics - Domperidone > 12 years only

If simple analgesia doesn’t work then Triptans may be used - only to e initiated by a specialist

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4
Q

RED FLAGS FOR HEADACHES

A 
Recent onset, continuous sever headache
Worse lying, better upright 
Worse on straining
Visual deterioration
Balance/coordination/gait proems
Pappiloedema
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5
Q

Febrile Convulsions

A

Seizure assoc. with fever - no other cause is found and there is no Hx of convulsions when afebrile

~5% of children
Most commonly 6 mo to 6 years

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6
Q

Febrile Seizures are most commonly From a High temperature caused by an infection such as…

A

Chicken Pox
Flu
Middle Ear infection
Tonsilitis

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7
Q

Symptoms of Febrile Convulsions

A

Gemeralised Tonic Clonic Seizure Assoc. with a fever
Tonic = Rigidity
Clonic = Uncontrolled Jerking

SIMPLE
   <15 minutes (generally less than 5)
   Wetting/soiling themselves
   Loss of consciousness
   Vomit/Drool/Foam at the mouth 
   Child may be drowsy following seizure

COMPLEX
>15 minutes
More than 1 seizure in 24hrs
Focal Neuronal Signs (affecting just 1 body area)

STATUS EPILLEPTICUS
Epilleptic seizure lasting more than 30 minutes
Near constant/constant state of seizing
Medical emergency and requires immediate Rx

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8
Q

Ix for Febrile Convulsions

A

Hx from Eye witness - Duration, Conscious level/behaviour before and after, FHx,

Examination
   Vital Signs
   Level of Consciousness 
   Rash (blanching/Non-Blanching) 
   Fontanelle meningism
   Other Signs of infection
Further Ix:
   Bloods: FBC, ESR, CRP, Glucose, U&amp;E
   Urine Micrscopy/Culture: Age <18mo
   LP
   ECG
   Consider EEG
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9
Q

ADMIT AND TREAT AS MENINGITIS IF ALARMING FEATURES…

A 
Drowsy before seizure or GCS <15 1 hour after event
Photophobia
Neck Stiffness - Kernia's sign
Petechial rash (non-blanching)
Bulging fontanelle
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10
Q

Mx of Febrile Convulsions

A 
Parental Advice and reassure 
Recovery Position DURING SEIZURE
Rx cause of the Fever
   Paracetamol
   Ibuprofen
   Abx if indicated
Seizure >5 minutes --> Benzos
Subsequent Febrile Seizures can be reduced
   Valproate/Benzo (PO)
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11
Q

What to do in Emergency Febrile Convlusion

A

Recovery position, Check ABC
Blood Glucose,
Apyretic if feasible
Rectal Diazepam (if seizure >5 minutes) or single dose Buccal Midazolam

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12
Q

Epilepsy Definitions

A

Fit - Epileptic Fit sudden onset/attack
Faint = Neuro=cardiogenic
Seizure = Fit assoc with LoC and synchronised jerking of the limbs and body. Abnormally excessive hyper synchronous discharge from a group of neurons.
Convulsion: seizure where predominance is motor activity

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13
Q

Aetiology of epilepsy

A 
Idiopathic
Trauma
Infection - meningitis, encephalitis
Malformations - Tuberous sclerosis
Electrolyte disturbances 
Metabolic disorders
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14
Q

IX into Epilepsy

A

EEG
Neuroimaging - MRI/CT
ECG
Bloods: GLucose, U&Es, FBC

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15
Q

Features: Generalised versus Focal

A

GENERALISED - Affects both hemispheres - LoC from start
Absence - Pt stops and Stares, unresponsive
Tonic Clonic - Eyes roll up, few myoclonic jerks, Loc,
incontinence, body goes stiff followed by rhythmic
jerking movement
Myoclonic - Preif electric shck like jerks in proximal
muscles.

FOCAL - Hits specific area of the Brain
Frontal Lobe - Contralateral Clonic Jerks, Simple
partial Seizure
Temporal Lobe - Behavioural Changes, Sensory
phenomena, De JaVu
Perietal Lobe - Vertigo, Sensory Symptoms. Speech
Disturbance
Occipital Lobe - Visual and autonomic features

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16
Q

Aetiology of Absence seizures

A

3 - 12 years old

1-2% of childhood epilepsy

17
Q

Signs/Symptoms of Absence seizures

A

Transient LoC for a few seconds with resumption of activity - STOP and STARE

18
Q

Aetiology of Infantile Spasms (WEST SYNDROME)

A

4-6 months

Often Assoc. with developmental Delay

19
Q

Signs/symptoms of of Infantile Spasms (WEST SYNDROME)

A

Repetitive violent flexion of limbs trunk and head followed by extension of Arms (SALAAM ATTACKS) while awake

Clusters of Myoclonic Spasms

20
Q

Examination in cases of headache`

A 
Growth parameters (OFC)
Sinuses, teeth, visual acuity
Fundoscopy
Visual Fields
Cranial Bruit
Focal Neurological signs
Cognitive and emotional status
Dx is largely clinical
21
Q

Migraine Versus Tension headache

A

Migraine Tension Headache
Hemicranial Pain Diffuse, symmetrical
Throbbing Band-like distribution
Abdo Px + N/V Present most of the time
Relieved by rest “Constant Ache”
Photo/Phonphobia
Visual/Sensory/motor aura
+ve FHx

Tension headache
Diffuse, symmetrical
Band-like distribution
Present most of the time - “constant ache”

22
Q

Ix of Epilepsy

A 
Hx - Eye witness account of episode
EEG - Not a great Dx tool but good to determine WHAT TYPE of Seizure
Neuroimaging - MRI/CT
ECG
Blood Tests
   Glucose/Urine Biochemistry
23
Q

Mx of epilepsy

A

Must be seen by specialist after 1st non-febrile seizure
Medical
Na Valproate - 1st line for generalised epilepsy
Carbamazepine - Focal Epilepsy
Benzodiazepines - Acute and Prolonged seizures
Ketogenic Diet
Vagal Nerve stimulation/Deep Brain Stimulation

Sx
Hemispherectomy

24
Q

DDx for Epilepsy

A 
Syncope
Febrile convulsion
Night Terrors
Fabricated Illness 
Migraie 
Narcolepsy

Paediatrics (19 decks)

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