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Neurology Flashcards

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1
Q

What is important in a neurological consultation in paediatrics?

A

Interactive
Avoid medical language
Time course of symptoms CRUCIAL
Perinatal, developmental, Fox

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2
Q

What is important in a developmental Hx in neurology?

A 
Motor milestones: gross and fine motor
Speech and language
Early cognitive development
Play - symbolic play and social behaviour
Self-help skills
Vision and hearing assessment
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3
Q

What should you observe in a neurological examination of a child?

A 
Appearance
Gait
Head skin
Skin findings
Observe
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4
Q

What is the second most common cancer in children?

A

Brain

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5
Q

What are the different types of headache disorder in children?

A

Isolated acute
Recurrent acute
Chronic progressive
Chronic non-progressive

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6
Q

What are the two worrying headache disorders in children?

A

Isolated acute

Chronic progressive

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7
Q

What should you ask in a recurrent or chronic headache Hx?

A

More than one type of headache?

Typical episode: warning, location, severity, duration, frequency

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8
Q

What should you examine in a headache exam?

A 
Growth parameters, OFC, BP
Sinues, teeth, visual acuity
Fundoscopy
Visual fields
Cranial bruit
Focal neurological signs
Cognitive and emotional status
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9
Q

What is the OFC?

A

Occipitofrontal Circumference (OFC)

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10
Q

What are indicators of childhood migraine?

A 
Associated abdominal pain, nausea, vomiting
Focal symptoms
Signs before/during/after: visual disturbance, parenthesis, weaknes
Pallor
Aggravated by bright light/noise
Relation to fatigue/stress
Helped by sleep/rest/dark, quiet room
FHx positive
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11
Q

What are signs it is a migraine as opposed to a tension headache?

A 
Hemicranial pain
Throbbing/pulsatile
Abdo pain, nausea, vomiting
Relieved by rest
Photophobia/phonophobia
Visual, sensory, motor aura
FHx positive
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12
Q

What are signs it is a tension headache as opposed to migraine?

A

Diffuse, symmetrical
Band-like distribution
Present most of the time
Constant ache

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13
Q

What is suggestive of raised intracranial pressure?

A

Aggravated by activities that raise ICP: coughing, straining at stool, bending
Woken from sleep with headache +/- vomiting

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14
Q

What is suggestive of an analgesic overuse headache?

A

Headache back before allowed another dose
Paracetamol/NSAIDs
Compound analgesics - cocodamol

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15
Q

What are activities that can raise ICP?

A

Coughing, straining at stool, bending

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16
Q

What are indications for neuroimaging?

A 
Features of cerebellar dysfunction
Features of raised ICP
New focal neurological deficits e.g. squint
Seizures (esp. focal)
Personality change
Unexplained deterioration of school work
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17
Q

What is the management for an acute attack migraine?

A

Pain relief

Triptans

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18
Q

What is the preventative management for migraines?

A 
Pizotifen
Propranolol
Amitryptyline
Topiramate
Valproate
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19
Q

What is the management for tension headaches?

A 
Reassure no sinister cause
MDT management
Underlying problems
Acute attacks: analgesia
Discourage analgesics in chronic TTH
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20
Q

What is a preventative treatment for TTH?

A

Amitriptyline

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21
Q

What is a convulsion?

A

Seizure where there is prominent motor activity

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22
Q

What is an epileptic seizure?

A

An abnormal excessive hyper synchronous discharge from a group of (cortical) neurons

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23
Q

What is epilepsy?

A

A tendency to recurrent, unprovoked (spontaneous) epileptic seizures

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24
Q

How is epilepsy diagnosed?

A

Clinically - with EEG for supportive evidence

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25
What is a seizure not necessarily?
Epileptic
26
What are examples of non-epileptic seizures and other mimics in children?
``` Acute symptomatic seizures Reflex anoxic seizure Syncope Parasomnias Behaviour stereotypies Psychogenic non-epileptic seizures (PNES) ```
27
What can acute symptomatic seizures be due to?
Hypoxia-ischaemia Hypoglycaemia Infection Trauma
28
What is a febrile convulsion?
A seizure occurring in infancy/childhood usually between 3mo-5yr associated with fever but no evidence of intracranial infection or defined cause for seizure
29
What is the commonest cause of acute symptomatic seizure in childhood?
Febrile convulsion
30
How can you distinguish between different seizure types?
Jerk/shake: clonic, myoclonic, spasms Stiff: tonic Fall: atonic/tonic/myoclonic Vacant attack: absence, complex partial seizure
31
What are epileptic fits chemically triggered by?
Decreased inhibition Excessive excitation Excessive influx of Na and Ca ions
32
What are the two main types of epileptic seizure?
Partial seizure | Generalised seizure
33
What type of seizure are the majority of seizures?
Generalised
34
What are the subtle types of seizure?
Absences, myoclonus, drop attacks
35
What questions should you ask when diagnosing epilepsy?
``` Is the paroxysmal event epileptic in nature? Is it epilepsy? What seizure type is it? What is the epilepsy syndrome? What is the ethology? What are the effects on the child? ```
36
Why does the EEG have limited value in diagnosing epilepsy?
Low sensitivity | False positives
37
What is the EEG useful for in diagnosing seizures?
Seizure type Seizure syndrome Etiology
38
What do you use for a diagnosis of epilepsy?
``` History Video EEG in convulsive seizures Interictal/ictal EEG MRI brain Genetics Metabolic tests ```
39
What is the management of epilepsy in children?
Anti-epileptic drugs (AED)
40
What is the role of AED?
To control seizures
41
How should you start children on AED's?
Slow upward titration until side-effects manifest of drug inefficient
42
What should be considered when selecting AEDs?
Age Gender Type of seizures and epilepsy
43
What can some of the side effects of AEDs be?
CNS Drowsiness Effect on learning, cognition, behaviour
44
What are first line AEDs for generalised epilepsies?
Sodium valproate | Levetiracetam
45
What are first line AEDs for focal epilepsies?
Carbamazepine
46
What are other therapies for seizures/epilepsy?
Steroids Immunoglobulins Ketogenic diet (drug-resistant epilepsies)
47
What are epilepsy management options which are not drugs?
Vagus nerve stimulation (VNS) | Surgery
48
What are examples of head size problems?
Macrocephaly | Microcephaly
49
When does the posterior fontanelle usually close?
2-3 months after birth
50
When does the anterior fontanelle usually close?
1-3 years
51
What is the head measurement roughly down between birth-3yrs in any child with neurological/developmental symptoms?
Occipitofrontal circumference (OFC)
52
When is microcephaly diagnosed as mild?
OFC <2 SD
53
When is microcephaly diagnosed as moderate/severe?
OFC <3 SD
54
What should you consider when diagnosing microcephaly?
Prenatal or postnatal onset? Timing of onset? Causes? (genetic/environmental)
55
What is the definition of macrocephaly?
OFC >2 SD
56
What should you consider when diagnosing macrocephaly?
``` Is it crossing gentiles upwards? Sutures? Fontanelles? Familial? Hydrocephalus? Large brain? Development? Other physical abnormalities? ```
57
What is the term for 'flat head'?
Plagiocephaly
58
What is the term for 'short head or flat at back'?
Brachycephaly
59
What is the term for 'boat shaped skull'?
Scaphocephaly
60
What is craniosynostosis?
The bones in a baby's skull join together too early
61
When should you suspect a NM disorder?
``` 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 ```
62
What gene does Duchenne Muscular Dystrophy affect?
Xp21 | Dystrophin gene
63
What are the signs/symptoms of Duchennes?
``` Delayed gross motor skills Symmetrical proximal weakness Elevated creatinine kinase levels Cardiomyopathy Respiratory involvement in teens ```
64
What are the levels of creatinine kinase usually like in Duchennes?
High | >1000
65
What are the signs of symmetrical proximal weakness in Duchenne's Muscular Dystrophy?
Waddling gait Calf hypertrophy Gower's sign positive
66
What is Gower's sign?
The sign describes a patient that has to use their hands and arms to "walk" up their own body from a squatting position due to lack of hip and thigh muscle strength.
67
What are physical signs of Duchenne's?
``` Shoulders/arms back when walking Sway back Weak butt muscles Knees may bend back to take weight Thick lower leg muscles - fat not strong Tight heel cord (contracture) Belly sticks out Poor balance Falls often Clumsy walking Weak muscles in front leg cause foot drop Tip toe contractures ```
68
What are examples of muscle neuromuscular conditions?
Muscular dystrophies Myopathies - congenital and inflammatory Myotonic syndromes
69
What is an example of a neuromuscular junction problem?
Myasthenic syndromes
70
What are examples of nerve neuromuscular conditions?
Hereditary or acquired neuropathies
71
What is an example of a anterior horn cell neuromuscular condition?
Spinal muscular atrophy
72
Where is the site of weakness in a neuropathy?
Distal weakness
73
Where is the site of weakness in a myopathy?
Usually proximal
74
What are the reflexes like in a neuropathy?
Reflexes lost early
75
What are the reflexes like in a myopathy?
Reflexes preserved until late
76
Are fasciculations common in neuropathies?
May be present
77
Are fasciculations common in myopathies?
Not typical
78
Are contractures a feature of neuropathies?
Not a feature
79
Are contractures a features of myopathies?
Yes
80
Is myocardial dysfunction a feature of neuropathy?
Not a typical feature
81
Is myocardial dysfunction a feature of myopathy?
May have accompanying cardiac dysfunction with dystrophies

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