Neurology / Neurodevelopment Flashcards
Main excitatory neurotransmitter
Glutamate
Main inhibitor neurotransmitter
GABA
Which spinal tract travels in the dorsal column and where does it cross midline?
Fine touch, vibration, proprioception
Crosses at the medualla
What is sensed by the spinothalamic tract and where does it cross midline?
Pain and temp
Crosses immediately at SC –> thalamus
What spinal tract is in the ventral horn and where does it cross the midline?
Motor tract
Crosses at level of medulla
What is Brown-Sequard syndrome and how does it present?
Hemi-section of SC
- Ipsilateral loss of fine touch, proprioception and motor
- Contralateral pain and temperature
Features of Charot-Marie-Tooth Syndrome
- Dominant
- Progressive damage to peripheral nerves - demyelination
- Peripheral weakness
- Hammer toes
- High arch feet
- Legs like upside down champagne bottles
- Reduced sensation
- Reduced nerve condution
Features of Rett Syndrome
Mostly girls
Mutation MECP2 gene
- Microcephaly
- GI disorder
- Seizures
What do nerve conduction studies test for?
Axonal degeneration = reduced amplitude
Demyelination = reduced velocity
Pathophysiology and features of MS
Rare in childhood
AI –> demyelination –> lesions in white matter –> demyelinating plaques
Relapsing / remitting neurological Sx
Ix: LP - oligoclonal bands, raised IgG. Evoked potentials.
ADEM - Pathophysiology, presentation, Ix and Tx
Immune mediated response to infection / vaccination –> monophasic acute demyelination in brain (white matter) and SC
Presents - Abrupt, fever, headache, drowsiness, coma, seizures, paresis, CN palsies
Ix: MRI, CSF mildly increased lymphocytes / protein
Tx: Support hydration, IV methylpred
Pathophysiology of migraines
- Genetic component
- NO - vasodilation
- Cortical spreading depression
- Raised seratonin / dopamine
Pathophysiology acute migraine treatment
- Triptans = 5-HT agonists –> block neurotransmission and reduced neuropeptide release
- Dopamine antagonists eg prochlorperazine
Pathophysiology of migraine prophylaxis
- Pizotogen >5y = seratonin/ histamine antagonist
- Propranolol >2y = beta-1 receptor antagonist, reduced noradrenergic action, altered GABA firing
Features and management of idiopathic intracranial HTN
- More in overweight teen girls
- Presents: Headache, nausea, visual disturbance, papilloedema
- Normal brain imaging, raised LP opening pressure
- Tx: Therapeutic LP, acetazolamide (reduced CSF production) +/- furosemide. If not effective, CSF shunt
Presentation of raised ICP
- Headache - more mornings / cough/ micturition
- Vomiting esp morning
- Focal neurological Sx
- Cushing’s sign - low HR, high BP, irregular resps
- Fluctuating mental state
Management raised ICP
- Close monitoring Co2/ glucose/ electrolytes/ temp in normal range
- Elevate bed 30 degrees, increased jugular flow
- Analgesia / sedation - reduced O2 demand
- Seizure prophylaxis
- Bolus 3% NaCl / mannitol
- Fluid restriction
- Surgical decompression
Causes of ischaemic stroke in children
- Perinatal - MCA - thrombotic from placenta
- Cardiogenic - CHD, arrhythmia, cardiomyopathy, infective endocarditis
- Thromboembolic eg vasculitis
- Haem - sickle cell, coagulation disorder
AEDs for generalised tonic clonic seizures
1st line: Sodium valproate
2nd line: Lamotrigine, levetiracetam
AEDs for tonic / atonic seizures
1st Line: Sodium Valproate
2nd Line: Lamotrigine
AEDs for absence seizures
1st line: Ethosuximide, sodium valproate
2nd line: Lamotrigine
AEDs for myoclonic seizures
1st line: Sodium valproate
2nd line: Levetiracetam, topiramate
AEDs for Focal seizures
1st line: Carbamazepine, lamotrigine
AEDs for Infantile spasms
Vigabatrin or Prednisolone
Vgabatrin only if Tuberous Sclerosis
