Neurology

Question 1

What are the signs of a migraine?

Answer 1

Hemi-cranial pain
Throbbing
Relieved by rest
Photophobia 
Phonophobia
Younger – abdominal pain, nausea, vomiting
Older – aura (visual, sensory, motor)

Question 2

How are migraines treated?

Answer 2

Acute attack – pain relief, triptans

Preventative if 1 or more per week – propranolol, pizotifen

Question 3

What are the symptoms of tension-type headaches?

Answer 3

Symmetrical
Band-like distribution
Present most of the time
Constant ache

Question 4

How are tension-type headaches treated?

Answer 4

Reassurance
Acute attacks – analgesia
Prevention – amitriptyline

Question 5

What are the causes of epilepsy?

Answer 5

None
Infection
Hyponatraemia
Toxins
Trauma
Tumour

Question 6

What are the 2 main types of seizures?

Answer 6

Partial/focal - affects 1 hemisphere

Generalised - affects 2 hemispheres

Question 7

How is epilepsy investigated?

Answer 7

History
Video recording
ECG in convulsive seizures
EEG – if + clinical diagnosis
MRI

Question 8

How is epilepsy treated?

Answer 8

Partial/focal – carbamazepine 
Generalised – sodium valproate (not in girls)
Lamotrigine
Other – steroids, immunoglobulins
Vagus nerve stimulation

Question 9

What are the side effects of anti-epileptics?

Answer 9

Drowsiness

Can affect learning, cognition and behaviour

Question 10

What are the signs of a febrile convulsion?

Answer 10

Rapid temperature rise
Simple – generalised tonic clonic, <15mins, only occur once in a single febrile illness
Complex – partial or focal seizures, >15mins, occur multiple times during the same febrile illness

Question 11

What age group does febrile convulsions affect?

Answer 11

6 months - 5 years

Question 12

What are the causes of febrile convulsions?

Answer 12

Fever caused by an underlying viral illness or bacterial infection

Question 13

How are febrile convulsions treated?

Answer 13

Analgesia

Question 14

How is duchenne muscular dystrophy inherited?

Answer 14

X-linked recessive

Question 15

What gene is defective in duchenne muscular dystrophy?

Answer 15

Defective gene for dystrophin on the X chromosome

Question 16

What are the signs of duchenne muscular dystrophy?

Answer 16

Symmetrical proximal weakness – waddling gait, calf hypertrophy, gower’s sign
Delayed gross motor signs
Cardiomyopathy

Question 17

What is Gower’s sign?

Answer 17

In duchenne muscular dystrophy

Children with proximal muscle weakness use a specific technique to stand up from lying

Question 18

How is duchenne muscular dystrophy treated?

Answer 18

No curative treatment
Occupational therapy
Physiotherapy
Oral steroids
Creatine supplement

Question 19

What are signs of raised intracranial pressure?

Answer 19

Headache aggravated by coughing, staining at stool, bending etc
Woken from sleep with headache +/- vomiting

Question 20

What are indications for neuroimaging with regards to headaches?

Answer 20

Features of cerebellar dysfunction
Features of raised intracranial pressure
New focal neurological deficit – eg new squint
Seizures – especially focal
Personality change
Unexplained deterioration of schoolwork

Question 21

What is a seizure fit?

Answer 21

Any sudden attack from whatever cause

Question 22

What is syncope?

Answer 22

Faint - neuro-cardiogenic mechanism

Question 23

What is a convulsion?

Answer 23

Seizure where there is prominent motor activity

Question 24

What is an epileptic seizure?

Answer 24

An electrical phenomenon

Question 25

What are other kinds of non-epileptic seizures?

Answer 25

Reflex anoxic seizure Parasomnia Psychogenic non-epileptic seizures

Question 26

When should you measure a child's head?

Answer 26

``` Every time you see them between birth and 3 years or any child with neurological symptoms Occipitofrontal circumference (OFC) ```

Question 27

Microcephaly

Answer 27

Mild – OFC <2 SD Moderate/severe – OFC <3 SD Normally indicates small brain (microencephaly) Has it always been a small head or is it not growing? Causes – antenatal, postnatal, genetic and environmental

Question 28

Macrocephaly

Answer 28

OCF >2 SD Can only grow if the sutures are still open Large brain? Development? Other physical abnormalities – facial features, hepatosplenomegaly, bony deformities etc

Question 29

Plagiocephaly

Answer 29

Flat head, squint | Ears at different levels

Question 30

Brachycephaly

Answer 30

Short head or flat at the back | Down syndrome

Question 31

Scaphocephaly

Answer 31

Boat shaped skull

Question 32

Craniosynostosis

Answer 32

Cranial sutures close too early impairing bone growth | Needs to be corrected within 1 year

Question 33

Deformational plagiocephaly

Answer 33

Reflects the in-utero position of the baby

Question 34

When would you suspect a neuromuscular disorder in a child?

Answer 34

``` 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 35

What is the pathology of cerebral palsy?

Answer 35

Disorder of movement and posture | Associated with a fixed insult to the developing brain

Question 36

What are the causes of cerebral palsy?

Answer 36

``` Pre-natal, peri-natal, post-natal: Ischaemia Congenital infection Neonatal meningitis Prematurity Kernicterus ```

Question 37

What are the symptoms of cerebral palsy?

Answer 37

Spastic – increased tone/reflexes, reduced power Dystonic – involuntary movements Ataxic – hypotonia, wide-based gait, nystagmus, intention tremor

Question 38

What investigations would be done if cerebral palsy was suspected?

Answer 38

Creatinine kinase - increased | CT/MRI

Question 39

How is cerebral palsy treated?

Answer 39

MDT

Question 40

What are causes of neonatal seizures?

Answer 40

``` Hypoxic-ischaemia encephalopathy Infection – meningitis/encephalitis Intracranial haemorrhage/infarction Structural CNS lesions Metabolic disturbance – hypoglycaemia Metabolic disorders Neonatal withdrawal from maternal drugs or substance abuse Kernicterus ```