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neurology Flashcards

1
Q

what are the 4 types of primary headache?

A
  • migraine
  • tension headache
  • cluster headache
  • cough / exertional headache
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2
Q

presentation of tension headache?

A
  • symmetrical
  • gradual onset
  • described as “tightness”, “band on head”
  • no other symptoms in kids
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3
Q

do most migraines present with or without aura?

A

90% are without aura

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4
Q

presentation of migraine without aura?

A
  • lasts 1-72h
  • usually bilateral
  • pulsing over temporal / frontal lobes
  • GI disturbance
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5
Q

what are the 3 types of aura?

A
  • visual
  • sensory
  • motor
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6
Q

give 2 examples of visual auras

A
  • vision loss (total or partial)

- seeing zig zag lines

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7
Q

causes of secondary headache?

A
  • head/neck trauma
  • RICP
  • infection
  • substance misuse/withdrawal
  • psychiatric disorder
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8
Q

which foods can trigger migraines?

A
  • cheese
  • chocolate
  • coffee
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9
Q

what can migraines be associated with in girls?

A
  • menstruation

- COCP

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10
Q

features of a headache from RICP/SOL?

A
  • worse when lying down
  • night-time waking
  • morning vomiting
  • change in mood/behaviour
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11
Q

potential presentation of RICP/SOL? there’s a LOT

A
  • visual field defects
  • squint
  • facial nerve palsy
  • abnormal gait
  • torticollis
  • growth failure
  • papilloedema (late feature)
  • cranial bruits
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12
Q

pain management for a primary headache?

A
  • paracetamol and NSAID asap
  • antiemetic (metoclopramide)
  • sumatriptan (5-HT agonist)
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13
Q

prophylaxis of primary headaches?

A
  • pizotifen (5-HT antagonist, causes weight gain and tiredness)
  • propanolol (CI in asthma because BB)
  • valproate (Na channel blocker)
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14
Q

what can epilepsy be secondary to?

A
  • vascular occlusion in brain
  • tumour
  • congenital infection
  • HIE
  • intraventricular haemorrhage / ischaemia
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15
Q

non-epileptic causes of seizure?

A
  • febrile
  • metabolic deficiency (hypoglycaemia, hypocalcaemia, hyponatraemia)
  • also HYPERnatraemia
  • head trauma
  • infection
  • poison/toxins
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16
Q

define a febrile seizure

A

seizure accompanied by fever in absence of intracranial infection

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17
Q

what type of seizure is a febrile seizure?

A

generalised tonic-clonic

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18
Q

how many children with a febrile seizure will have another?

A

40%

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19
Q

what is the risk of going on to develop epilepsy after a simple febrile seizure?

A
  • 1-2%

- same as every other kid

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20
Q

why is a septic screen so important in an infant with febrile seizures?

A
  • the signs of meningitis are not as clear in them

- (usually the fever is from a viral illness)

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21
Q

management of a prolonged (>5 mins) febrile seizure?

A
  • rectal diazepam

- OR buccal midazolam

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22
Q

causes of reflex anoxic siezures?

A
  • minor head trauma
  • cold food like ice cream
  • fright
  • fever
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23
Q

features of a reflex anoxic seizure?

A
  • after the triggering event, child goes pale
  • falls to floor
  • generalised tonic-clonic seizure
  • rapid recovery
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24
Q

physical signs of a migraine?

A
  • unsteadiness

- light-headed sensation

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25
what makes a breath-holding episode different from a reflex anoxic seizure?
- both in toddlers - BHE brought on by anger vs pain in RAS - BHE goes blue vs pale in RAS
26
presentation of absence seizures?
- transient LOC - may be eyelid flickering - could be preceded by hyperventilation
27
presentation of myoclonic seizures?
- repetitive limb jerking | - that's how hiccups work!!
28
presentation of tonic seizures?
increased tone everywhere
29
presentation of tonic-clonic seizures?
- rhythmic contractions of muscle groups following a hypertonic phase - lasts secs-mins - irregular breathing - maybe cyanosis - tongue biting - urinary incontinence - LOC / deep sleep for hours afterwards
30
presentation of atonic seizures?
- transient loss of muscle tone - sudden fall to floor / drop of head - often combined with myoclonic jerk
31
where is the lesion in a focal seizure with motor phenomena?
frontal lobe
32
where is the lesion in a focal seizure with smell/taste phenomena?
temporal lobe
33
where is the lesion in a focal seizure with visual phenomena?
occipital lobe (can be positive or negative phenomena)
34
where is the lesion in a focal seizure with contralateral altered sensation?
parietal lobe
35
which AED is contraindicated in absence or myoclonic seizures?
carbamazepine (makes these worse)
36
what do children prone to prolonged epileptic seizures carry with them?
buccal midazolam as a rescue therapy
37
when can AED therapy be stopped?
after 2 years of being seizure-free
38
adverse effects of valproate?
- weight gain - hair loss - teratogenic - liver failure
39
adverse effects of carbamazepine?
- rash - hyponatraemia - ataxia - interacts with COCP
40
which investigation is used to classify type of seizure in epilepsy?
inter-ictal EEG
41
when should an AED be prescribed?
- when seizures are intrusive | - when the type of epilepsy is known (think carbamazepine!)
42
presentation of cerebral palsy?
- hypotonia (floppy) - delayed motor milestones - muscle weakness - unsteady / abnormal gait - easily fatigued - muscle cramps (from myopathy)
43
a) describe a positive Gower's sign b) is it ever normal? c) where is this seen pathologically?
a) turning prone to start getting up, then holding onto knees to get upright b) normal up to until the age of 3 c) cerebral palsy, DMD
44
describe Charcot-Marie-Tooth disease presentation
- symmetrical - slow progressing - distal muscle wasting - preschoolers will trip up in school from acute bilateral foot drop - pes cavus
45
what causes Charcot-Marie-Tooth disease?
gene mutation CMTA1
46
investigation in Charot-Marie-Tooth? what is found?
nerve conduction studies show mixed neuropathy
47
name 3 peripheral neuropathies?
- Charcot-Marie-Tooth disease - Guillain-Barre syndrome - Bell palsy
48
a) what causes guillain-barre syndrome? | b) when does it present?
a) URTI or campylobacter gastroenteritis | b) any age, 2-3 weeks after the infection
49
presentation of guillain-barre syndrome? there's a LOT
- ascending, progressive weakness - symmetrical - loss of tendon reflexes - loss of autonomic involvement - arrhythmias - difficulty chewing and swallowing (bulbar muscles) - bilateral face weakness - some sensory symptoms in distal limbs + trunk
50
investigations for guillain-barre syndrome?
- MRI of spinal cord | - CSF has raised protein, normal WCC
51
management for guillain-barre syndrome?
- support respiration with ventilation | - otherwise it just recovers by itself
52
what is Bell palsy?
isolated LMN paresis of facial nerve
53
presentation of Bell palsy?
- unilateral facial weakness | - upper and lower face affected
54
management of Bell palsy?
- most cases recover by themselves | - corticosteroids help with facial oedema
55
main complication of Bell palsy?
conjunctivitis from not being able to shut your eye properly
56
age group affected in juvenile myasthenia gravis?
> 10 year olds
57
presentation of myasthenia gravis?
- ophthalmoplegia - ptosis - loss of facial expression - difficulty chewing - proximal weakness - thymoma
58
how is myasthenia gravis diagnosed? there are 2 ways
- by watching an improvement over days after administering oral pyridostigmine - finding anti-MuSK antibodies (rare)
59
management of myasthenia gravis?
- pyridostigmine (choline esterase inhibitor) - prednisolone - rituximab - thymectomy if thymoma
60
what is the commonest muscular dystrophy?
Duchenne
61
pattern of inheritance of Duchenne muscular dystrophy?
X-linked recessive (only boys affected)
62
what is seen on bloods in Duchenne muscular dystrophy?
raised creatinine kinase (from muscle breakdown)
63
presentation of Duchenne muscular dystrophy?
- waddling gait - language delay - runs slower than peers - climbs stairs slower - positive Gowers sign - pseudohypertrophy of calves (fatty tissue replacing muscle)
64
central causes of hypotonia?
- Down syndrome - Prader-Willi syndrome - hypothyroidism - cerebral palsy
65
peripheral causes of hypotonia?
- spinal muscular atrophy - spina bifida - Guillain-Barre syndrome - myasthenia gravis - muscular dystrophy - myotonic dystrophy
66
a) which brain bleed is commonest following trauma? | b) which artery is most likely to be affected?
a) extradural haemorrhage | b) middle meningeal artery
67
presentation of extradural haemorrhage?
- post-traumatic - lucid interval - then reduced consciousness - dilated ipsilateral pupil - paresis of contralateral limbs - false localising CN6 palsy
68
investigation finding in extradural haemorrhage?
CT head shows lentiform shaped bleed
69
which brain bleed is most likely following NAI, e.g. violently shaking a baby
subdural haematoma
70
investigation finding in subdural haemorrhage?
CT head shows crescent shaped bleed
71
investigation finding in a subarachnoid haemorrhage?
CT head shows star shaped bleed
72
what is spina bifida?
failure of the vertebral column to close properly
73
early presentation of spina bifida?
- could be found antenatally - incidental finding on X-ray - skin lesion on lumbar region
74
later presentation of spina bifida?
- lower limb paresis + hypotonia - dislocated hip from uneven muscle growth - sensory loss - bladder + bowel dysfunction - scoliosis - hydrocephalus
75
management of spina bifida?
- surgically fix it after birth - physiotherapy for muscle bulk - skin care to prevent ulcers - long-term catheter - regular toileting and laxatives
76
a) what are the 2 types of hydrocephalus? | b) what is the difference?
a) obstructive and communicating | b) obstructive stops CSF flow within the ventricular system, communicating stops CSF being reabsorbed
77
features of hydrocephalus in infant?
- bulging fontanelles - rapidly growing head circumference - "sun setting" sign is fixed downward gaze
78
management of hydrocephalus?
ventriculoperitoneal shunt
79
features of hydrocephalus in an older child?
RICP signs, same as adult

paediatrics (10 decks)

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