Neurology Flashcards
(24 cards)
Definition of cerebral palsy
A dynamic/changing disorder of posture and movement caused by a non-progressive lesion to the developing brain
“CP describes a group of permanent disorders of the devlopment of movement and posture, causing activity limitations that are attributed to non-progressive disturbances that occurred in the developing foetal or infant brain. The motor disorders of cerebral palsy are often accompanied by distubrances of sensation, perception, congition, communication, and behaviour; by epilepsy and by secondary MSK problem.”
Causes of cerebral palsy
Antenatal - toxins, teratogens, inutero infection
Perinatal - hypoxic insult, sepsis
Postnatal - meningitis, trauma
Tetraplegic =
All four limmbs implies a lesion to both hemispheres, this may be causes by a global hypoxic ischaemic injury
Hemiplegic =
One side of the body, a lesion of one hemisphere which may be caused by an antenatal stroke
Diplegic =
Affecting lower limbs, implies a lesion of the white matter at the back of the brain (periventricular leukomalacia) typically associated with prematurity
Co-morbidities in cerebral palsy
Epilepsy Learning difficulties Behaviour problems Feeding problems/gastro-oesophageal reflux Osteoporosis
Management of cerebral palsy
Define the underlying aetiology
Promote/support participation in all aspects of society through practical measures, education and legislation
MDT approach - physician, phsyiotherapist, OT, SALT, dietician, nurse speciailist
Mx comorbidites e.g. epilepsy and feeding problems
Prevent deformity - PT, botulinum toxin, surgery in special situations
What medication and dose can help prevent neural tube defects
Folic acid - 400 microg/day 1 month prior to conception
Spina bifida - limitations of community ambulators
Community ambulators (L3 levels and lower) are able to walk indoors and outdoors for most activities, although a wheelchair may be used for longer trips outside their immediate vicinity
Spina bifida - limitations of household ambulators
Household ambulators (L3 or mid lumbar) may be able to walk indoors and transfer to a wheelchair for community use and most outdoor activity
Spina bifida - limitations of non-functional ambulators
Non-funcitonal ambulators (L1 to L3) may walk as part of a therapy session or in a gymnasium with orthotic devices, but use a wheelchair for any useful mobility needs
Spina bifida - limitations of non-ambulators
Non-ambulators use a wheelchair for indoor and outdoor activities
Definition of myelomeningiocele
Outpouching of the spinal cord and its coverings through a defect in posterior elements of vertebral arches
Cervical cord and brainstem are likely to be affected - the Chiari malformation
Associated problems of myelomeningocele
Mobility, sensation, bowel and bladder function, hydrocephalus, specific learning problems
What is seen when examining a child with spina bifida
Flaccid weakness of the lower limbs, reflexes will be absent and there will be a lack of sensation. Look for evidence of a ventriculo-peritoneal shunt and examine the back
Aetiology of muscular dystrohyt
Duchenne muscular dystrophy and becker muscular dystrophy are due to mutations in the X-liked dystrohin genes. In Becker there is preserved weakness but a significatn amount of normal dystrophin is preserved.
Clinical diagnosis of muscular dystrophy
Signs of muscle weakness, lumbar lordosis, calf muscle hypertrophy, learning (particularly speech) problems in some cases. Gowers sign
Ix of muscular dystrophy
Elevated creatinine kinase, @DNA testing for mutations in the dystrophin gene. Later monitoring of respiratory and cardiac function and scoliosis
Mx of muscular dystrophy
Genetic counselling, PT, aids for ambulation, resp support, scoliosis surgery, steroids, potential for gene therapy
Definition of epileptic seizure
A transient occurrence of sings and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain
Definition of epilepsy
Epilepsy is a disease f the brain defined by any of the following conditions:
- At least 2 unprovoked seizures occurring more than 24 hours apart
- One unprovoked seizure and a probability of further seizures similar similar to the general recurrence risk after 2 unprovoked seizures (approx 75% or more)
- At least 2 seizures in a setting of reflex epilepsy
Causes of non-epileptic seizures
Syncopes and anoxic seizures Psychological/behaviour disorders Derangements of the sleep process Paroxysmal movement disorders Migraine equivalents Micellaneous neurological events
Top 5 facts on positional plagiocephaly
Incidence increased following ‘Back to Sleep Campaign’.
Prevention/improvement can be achieved by encouraging ‘tummy time’ for playing, positioning toys/windows/people on the less preferred side and alternating lying direction in cot. Limit time in bouncy chair/car seat.
If baby’s head is always turned in one direction consider torticollis and refer for physio.
No firm evidence exists that moulded helmets or bands work.
Resolves over time. Usually by school age, no noticeable flattening remains. If there are concerns regarding early closure of suture lines
(over-riding sutures, abnormal head shape from birth) referral to paediatrics/neurosurgery is required to exclude craniosynostosis
Facts on febrile convulsion
3% of children in the UK will have a febrile convulsion
Aged 6 months to 5 years (outwith this range warrants closer investigation)
No association underlying pathological abnormality.
Recur in 30% of kids
3% will progress to having epilepsy (more likely if complex febrile seizures)
