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Neurology Flashcards

1
Q

A child presents complaining of headaches, what would you want to ask?

A
  • Recurrence?
  • More than 1 type?
  • Warning?
  • SOCRATES
  • Use of analgesia?
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2
Q

What would you examine on a kid with a headache?

A 
Growth parameters (height, weight, OFC, BP)
Sinuses & teeth
Visual acuity, fields and fundoscopy
Listen for cranial bruit
Focal neurological signs
Cognitive/emotional status
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3
Q

Headaches in kids fall into 4 groups:

A
  • Migraines
  • TTHs
  • Raised ICP
  • Analgesic Overuse
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4
Q

How would you make the diagnosis of a migraine?

A

Hemicranial, throbbing & pulsatile headache

Relieved by rest
Often photo/phonophobic

Presence of an aura

Also useful to look for FH

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5
Q

How would you diagnose a tension type headache?

A

If a child sufferes from a constant diffuse, symmetrical (band-like distribution) headache

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6
Q

How would you treat a migraine?

A

Give them simple analgesics for acute attacks
Maybe Triptans if bad enough

If atleast 1/wk give preventative drugs:

  • Propranolol
  • Amitriptyline
  • Valproate
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7
Q

How do you manage a tension type headache?

A

Reassure the parent it’s nothing sinister

Attend to chronic underlying physical/psychological/emotional stressors

Discourage chronic use of analgesics

If necessary you can use simple analgesics acutely and amitriptyline preventatively

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8
Q

How would you spot a medication overuse headache

A

High use of PCM/NSAIDs (more problematic if with compound analgesics e.g. cocodamol)

Pain returns before they can have another dose

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9
Q

What would be red flags of a raised ICP headache?

A
  • Wakens them from sleep

- Aggravated by raising ICP e.g. coughing, toilet straining or bending over

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10
Q

Headaches are diagnosed clinically, when would you want to use imaging?

A

1) Cerebellar dysfunction e.g. ataxia
2) Raised ICP
3) New focal deficit e.g. new squint
4) Seizures
5) Personality change
6) Unexplained deterioration in schoolwork

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11
Q

What are the major causes of fits/falls/funny turns in kids?

A

1) Epilepsy
2) Acute Symptomatic seizures e.g. febrile convulsion
3) Reflex Anoxic Seizures
4) Syncope
5) Parasomnias e.g. night terrors
6) Psychogenic Seizures

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12
Q

What causes reflex anoxic seizures?

A

Trigger e.g. pain or fright –> Vagal overactivity –> bradycardia –> hypoxia & seizure

It’s not abnormal in toddlers

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13
Q

What is an Acute Symptomatic Seizure?

A

A response to an acute insult e.g. hypoglycaemia, infection or hypoxia

The most common form is a Febrile Convulsion (very common, ~1in20 kids). Seizure ass with fever but with no intracranial inf or defined cause

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14
Q

What can you use to diagnose epilepsy?

A

Mostly a clinical diagnosis!!!

  • History
  • Video recordings
  • ECG
  • Interictal/Ictal EEG
  • MRI (For malformations)
  • Genetics (Familial & single gene disorders e.g. Tuberous Sclerosis)
  • Metabolic tests if ass with developmental delay
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15
Q

What causes epilepsy in kids?

A

Mostly it’s idiopathic

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16
Q

Is childhood epilepsy generalised or focal?

A

Mostly generalised

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17
Q

What factors are important when determining drug treatment for epilepsy?

A
  • Age
  • Gender
  • SEizure type
  • Epilepsy type
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18
Q

What drugs do we use for childhood epilepsy?

A 
Generalised = Sodium Valproate
Focal = Carbamazepine

New better tolerated drugs e.g. Lamotrigine

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19
Q

What are the major SEs of Anti-Epileptic Drugs (AEDs)?

A

CNS - Drowsiness, impacted learning, cognition & behaviour

Others include rashes & bone marrow problems

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20
Q

Other than AEDs how can you treat epilepsy?

A

Some forms respond to Vagus Nerve Stimulation or Surgery

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21
Q

What signs would raise concern of a neuromuscular disorder in a pre-walking child?

A
  • Floppy
  • Slips from hands
  • Paucity of limb movements
  • Alert but low motor activity
  • Delayed motor milestones
  • Myopathic facies
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22
Q

What signs would suggest a neuromuscular disorder in a walking child?

A
  • Frequent falls
  • Awkward/clumsy positioning e.g. holding shoulders back, belly out, walking on toes
  • Gait e.g. waddling
  • Pes Cavus & hammer toes
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23
Q

What is pes cavus and hammer toes indicative of?

A

Charcot Marie Tooth Disease

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24
Q

How can you differentiate a neuropathy from a myopathy?

A

Myopathy:

  • Proximal weakness
  • Purely motor
  • Preserved reflexes
  • Contractures
  • ~Myocardial dysfunction

Neuropathies:

  • Distal weakness
  • ~sensory involvement
  • Loss of reflexes
  • ~Fasciculations
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25
List some of the major neuromuscular disorders in kids?
Muscular dystrophies e.g. Duchenne's Spinal Atrophy Myasthenia Gravis
26
How is Duchenne's MD inherited?
X-linked --> female carriers and male suffers Xp21 - the dystrophin gene
27
How would you expect Duchenne's MD to present?
``` Delayed gross motor skills Symmetrical proximal weakness Waddling gait Calf hypertrophy Gower's Sign ``` ~ Cardiomyopathy & Resp involvement in teens
28
How do you confirm Duchenne's?
Gower's sign (required but not specific) Raised Creatinine kinase CK (>1000)
29
How do we treat Duchenne's?
Steroids, thanks to this sufferers can stay on their feet etc much longer and live into early 30s
30
What's the most common cause of collapse in kids/adolescents?
Vasovagal Syncope
31
What questions would you ask about a collapse/fit/fall to ascertain cause?
- Any precipitant? - Any prodromal symptoms? - Timescale - Time to recover - Fh of epilepsy, syncope etc - H/o collapse - Fever/illness 3rd party: - Eye movement - Limb movement - Colour - Response/consciousness
32
What can cause vasovagal syncope?
- Missing meals (hypoglycaemia) - Dehydration - Stress - Posture change - Heat - Straining - Blood taking - Arrythmia e.g. Long QT
33
What can you test in syncope?
Glc at the time ECG for arrhythmia BP for hypotension
34
What advice would you give someone who suffers from syncope?
- Reassure that it's not something serious - Drink lots - Have proper meals - Take care on changing posture - Return if it recurs - Exercise legs (improves venous return)
35
What is the second most common cancer in children?
brain tumour
36
how many children present with migraines?
7.7% of children 10-17
37
pointers (other than typical symptoms) which suggest childhood migraine?
Associated abdominal pain, nausea, vomiting Focal symptoms/ signs before, during, after attack: Visual disturbance, paresthesia, weakness ‘Pallor’ Aggravated by bright light/ noise Relation to fatigue/ stress Helped by sleep/ rest/ dark, quiet room Family history often positive
38
seizure/fit def?
Any sudden attack from whatever cause
39
Syncope def?
Faint (a neuro-cardiogenic mechanism)
40
convulsion def?
Seizure where there is prominent motor activity
41
Epileptic seizure def?
An abnormal excessive hyper synchronous discharge from a group of (cortical) neurons It may have clinical manifestations Paroxysmal change in motor, sensory or cognitive function Depends on seizure’s location, degree of anatomical spread over cortex, duration
42
examples of non-epileptic seizures?
Acute symptomatic seizures: due to acute insults eg. Hypoxia-ischaemia, hypoglycemia, infection, trauma Reflex anoxic seizure: common in toddlers Syncope Parasomnias eg. night terrors Behavioural stereotypies Psychogenic non-epileptic seizures (PNES)
43
what is Microcephaly?
OFC <2 SD: mild OFC <3 SD: moderate/ severe
44
what does microcephaly indicate?
small brain | ‘micranencephaly’
45
causes of microcephaly?
antenatal, postnatal, genetic and environmental
46
definition of macrocephaly?
OFC > 2SD
47
what is Plagiocephaly
‘flat-head’
48
what is Brachycephaly
‘short head or flat at back’
49
what is scaphocephaly?
‘boat shaped skull’
50
Craniosynostosis
baby's skull join together too early.
51
Deformational plagiocephaly
a flat spot on one side of the head or the whole back of the head.
52
Craniosynostosis
a condition in which one or more of the sutures close too early, causing problems with normal brain and skull growth.
53
what chemically triggers an epileptic seizure?
epilepsy is caused by excessive for cortical neurones - Decreased inhibition (gama-amino-butyric acid, GABA) - Excessive excitation (glutamate and aspartate) - Excessive influx of Na and Ca ions resulting in large scale depolarisation
54
how does chemical stimulation cause an epileptic fit?
Chemical stimulation produces an electrical current Summation of a multitude of electrical potentials results in depolarization of many neurons which can lead to seizures, can be recorded from surface electrodes (Electroencephalogram)
55
why is an epilepsy diagnosis challenging?
Non-epileptic paroxysmal disorders are more common in children Difficulty in explaining (Children are not young adults) Difficulty in interpretation (witness) Difficulty in interpretation and synthesising information(physician)
56
pros and cons with EEG and epilepsy?
limited value in deciding when the individual has epilepsy Problematic false positive rates: paroxysmal activity seen in 30%, frankly epileptiform activity in 5% of normal children BUT good at identifying seizure types
57
How do a Childs frontage's close?
1. the posterior frontalles usually close 2-3 months after giving birth 2. The anterior frontalles closes between 1-3 years
58
when measuring head size need to plot on graph with weight and heigh..
...
59
what exactly do you measure? OFC?
occipital frontal circumference
60
when do you measure OFC? when is it important to measure? do u measure parents?
as routine- between birth and 3 years of age VERY important v important if neurological or developmental symptoms also measure parents head size tp see if it is going along with families
61
most common weird head shape?
Deformational plagiocephaly looks like from the top parallels gram shape flattering at the back and frontal bone more prominent
62
how does craniocinositis look like?
-fusing too early | caronal, saggitol or lambdoid

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