Neurology

Question 1

What are the types of headache (time) in children?

Answer 1

Isolated acute
Recurrent acute
Chronic progressive
Chronic non-progressive

ISOLATED ACUTE AND CHRONIC PROGRESSIVE MAY REQUIRE MORE INVESTIGATION

Question 2

What features of examination can identify primary vs secondary headache?

Answer 2

Growth parameters, OFC, BP

Sinuses, teeth, visual acuity

Fundoscopy

Visual fields (craniopharyngioma)

Cranial bruit

Focal neurological signs

Cognitive and emotional status

Question 3

Childhood migraine features

Answer 3

Associated abdo pain, nausea, vom

Focal symptoms/signs before, during, after: visual disturbance, paresthesia, weakness

Pallor

aggravated by bright light/noise

Relation to fatigue/stress

Helped by sleep/rest/dark/quiet room

FHx often positive

Question 4

What are pointers to raised intracranial pressure?

Answer 4

Aggravated by activities that raise ICP e.g. coughing, straining at stool, bending

Woken from sleep with headache ± vomiting

Question 5

Describe analgesic overused headache

Answer 5

Headache back before allowed to use another dose

Paracetamol/NSAIDs

Particular problem with compound analgesics eg. cocodamol

Question 6

What are indications for neuroimaging?

Answer 6

Features cerebellar dysfunction

Features raised intracranial pressure

New focal neurological deficit i.e. new squint

Seizures esp. focal

Personality change

Unexplained deterioration of school work

Question 7

Migraine treatment

Answer 7

Acute attack; effective pain relief, triptans

Preventative; (at least 1/week); Pizotifen, propranolol, amitryptyline, topiramate, valproate

Question 8

TTH treatment

Answer 8

Aim at reassurance

MDT management

Attention to underlying chronic physical, psychological or emotional problems

Acute attacks; simple analgesia

Prevention; amitryptyline

Discourage analgesics in chronic TTH

Question 9

What is a seizure/fit?

Answer 9

Any sudden attack from any cause

Question 10

What is syncope?

Answer 10

Faint (neuro-cardiogenic mechanism)

Question 11

What is a convulsion?

Answer 11

seizure with prominent motor activity

Question 12

What is an epileptic seizure?

Answer 12

Electrical phenomenon

Abnormal excessive hyper synchronous discharge from a group of neurons

May have clinical manifestations

paroxysmal change in motor, sensory or cognitive function

Question 13

What is epilepsy?

Answer 13

Tendency to recurrent, unprovoked epileptic seizures

Question 14

Describe non-epileptic seizures in children

Answer 14

Acute symptomatic seizures; due to acute insults eg. hypoxia-ischaemia, hypoglycaemia, infection, trauma

Reflex anoxic seizure; common in toddlers

Syncope

parasomnias eg night terrors

Behavioural stereotypies

Psychogenic non-epileptic seizures

Question 15

Describe febrile convulsion

Answer 15

Occurring in infancy/childhood between 3months-5yrs

Associated with fever but without evidence of intracranial infection

Question 16

What are different features of seizures?

Answer 16

Jerk/shake; clonic, myoclonic, spasms

Stiff; usually tonic

Fall; atonic/tonic/myoclonic

Vacant attack; absence, complex partial seizure

Question 17

Describe atonic seizures

Answer 17

Loss of muscle strength (may drop/fall)

Question 18

Describe tonic seizures

Answer 18

Tense up

Question 19

Describe myoclonic seizures

Answer 19

brief shock-like jerks in muscle groups

Question 20

Describe tonic-clonic seizures

Answer 20

Tonic phase first; tense up

Clonic phase; rhythmic jerking movements

Question 21

Describe absence seizures

Answer 21

May have slight eye rolling/eyelid flickering

Question 22

What is the mechanism of an epileptic fit?

Answer 22

Chemically triggered by

• decreased inhibition (GABA)
• excessive excitation (glutamate and aspartate)
• excessive influx of Na and Ca ions

Question 23

What are the types of epileptic seizure?

Answer 23

Partial

Generalised

Question 24

What is EEG useful for?

Answer 24

Limited value in determining if an individual has epilepsy

Useful in identifying seizure types, seizure syndrome and aetiology

Question 25

What investigations are carried out for epilepsy?

Answer 25

ECG in convulsive MRI Brain; to determine aetiology Genetics Metabolic tests; esp if associated with developmental delay/regression

Question 26

What are epilepsy treatments?

Answer 26

Sodium valproate (not girls) or levetiracetam is first line for generalised epilepsies Carbamazepine first line for focal epilepsies

Question 27

Describe vagus nerve stimulation

Answer 27

Epilepsy treatment Sends tiny electric shocks to vagus nerve - programmable generator - lead with two coils at end - hand-held magnet

Question 28

When do the fontanelles close?

Answer 28

At birth; anterior and posterior fontanelles Posterior fontanelle closes first (by 3 months) Anterior fontanelle closes between 18months and 2.5years

Question 29

Describe measuring head circumference

Answer 29

Occipitofrontal circumference Just above eyebrows and over occipital prominence

Question 30

Describe microcephaly

Answer 30

OFC <2SD; mild OFC <3SD; moderate/severe Usually indicates small brain Crossing centiles/downwards Timing of onset

Question 31

Describe macrocephaly

Answer 31

OFC>2SD Crossing centiles upwards? Sutures? Fontanelles? Familial? Hydrocephalus? Other physical abnormalities; facial features, bony deformities etc

Question 32

Describe head shape problems

Answer 32

Often 1st year life Plagiocephaly = flat head Brachycephaly = short head or flat at back Scaphocephaly = boat shaped Craniosynostosis = cranial suture(s) fuse too early

Question 33

When to suspect a NM disorder?

Answer 33

Baby 'floppy' from birth Slips from hands Paucity of limb movements Alert, but less motor activity delayed motor milestones Able to walk but frequent falls

Question 34

Describe DMD

Answer 34

Xp21, dystrophin gene Delayed gross motor skills Symmetrical proximal weakness; waddling gait, calf hypertrophy, Gower's sign positive Elevated creatinine kinase levels Cardiomyopathy resp involvement in teens

Question 35

Describe myopathic facies

Answer 35

Tented upper lip Ptosis

Question 36

What are anatomical approaches to neuromuscular conditions?

Answer 36

Muscle; muscular dystrophies, myopathies, myotonic syndromes NMJ; myasthenic syndromes Nerve; hereditary or acquired neuropathies Anterior horn cell; spinal muscular atrophy