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Paediatrics > Paediatric: Nervous system > Flashcards

Paediatric: Nervous system Flashcards

1
Q

What is cerebral palsy and how is it caused?

A

Cerebral palsy is caused by a lesion during development due to a static injury

It is characterised by abnormal movement and posture and impairment in cognition, language, communication, perception, sensation also MSK abnormalities

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2
Q

What are the key features of cerebral palsy in children?

A

Abnormal movement and posture - 90% spastic, 6% dyskinetic, 4% ataxic

Difficulty feeding - poor oromotor coordination, gagging, vomiting, slow feeding

Abnormal gait (once and if walking begins)

Assymetric hand use < 12 months

Delayed motor milestones (1-18 months)

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3
Q

What is the primary cause of spastic cerebral palsy? what are its features? (tip there are two main types)

A

UMN lesion in pyramidal/cortiospinal tract

  1. Spasticity i.e. increased tone with dynamic catch (tone increases with velocity of movement)
  2. Increased plantar reflexes

Hemiplegia presents at 4-12 months
- U/L motor paresis/plegia, fisting, flexed arm, pronated forearm, asymmetric hand function, tip-toe walking,

Quadraplegia due to hypoxic injury
- scissoring of legs, microcephalic, opisothotonos, seizures, SEVERE intellectual imp.

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4
Q

What are the causes of Cerebral palsy?

A

80% ante-natal causes e.g. TORCH, vascular occlusion
10% hypoxic injury
10% post-natal - meningitis, encephalitis, hypoglycaemia

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5
Q

Explain the features of ataxic, dyskinetic and athetoid CP?

A

Ataxic - ataxic gait (wide based, unsteady trunk, poor coordination)

Dyskinetic - involuntary movements

Athetoid - writhing movements

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6
Q

What are the features of Febrile convulsion?

A
  1. Fever > 37.0
  2. Convlusions
    - Myoclonic - shock like movement of one or multiple parts of body
    - Clonic - rhythimic jerking
    - Tonic - Stiff
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7
Q

When are febrile convulsions most common (age)?

A

6 months to 5 years

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8
Q

What is the management of febrile convulsions?

A
  1. Paracetamol - control temp and reduce secure risk

2. Rescue pack of rectal diazepam or buccal midzolam

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9
Q

What is the similarity and differences between generalised and focal seizures?

A

Both are due to hyperproliferation of neurones in the cerebrum

Generalised arises from both hemispheres and involves impairment of consciousness

Focal arises from one lobe of a single hemisphere and may or may not involve impairment of consciousness?

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10
Q

Tell me the 6 types of generalised seizure and their features

A
  1. Myoclonic - electric shock like movement of one limb or multiple parts of body
  2. Clonic - rhythmic jerking
  3. Tonic - sustained stiff contractions
  4. Tonic-clonic
  5. Atonic - myoclonic seizures followed by complete paralysis
  6. Absence - period of 5-15seconds of unresponsiveness
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11
Q

Explain the 4 types of focal seizures?

A
  1. Frontal - dystonic
  2. Occipital - flashing, multicoloured lights
  3. Temporal - acute gastric discomfort, memory disturbances, anxiety
  4. Parietal - heme-sensory disturbance
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12
Q

What is the definition of and acute management of status epileptics?

A

Seizure lasting > 5 mins

  1. ABCDE - start the clock
  2. Oxygen
  3. Midzaolam (buccal) or Diazepam (rectal) or Lorzepam (IV)
  4. Lorazepam IV
  5. Phenytoin
  6. RSI
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13
Q

What is the criteria of migraine without aura?

A

A. ≥ 5 attacks fulfilling B-D
B. Lasts 1-48hrs
C. ≥ 2 of: U/L or B/L; pulsating; aggravated by normal activity; mod-sev intensity
D. ≥ 1 of: Nausea + vomiting; photo/phonophobia

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14
Q

What is the criteria for migraine with aura?

A

A. Lasts 1-48hrs
B. ≥ 2 attacks fulfilling C
C. ≥ 3 of: ≥ 1 episode of reversible aura; aura developing gradually over ≥ 4 mins; aura < 60mins; headache follows aura < 60mins

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15
Q

What is the treatment for migraine?

A
  1. Paracetamol and domperidone
  2. Weight loss
  3. Propanolol (prophylaxis)
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16
Q

What are the feature of raised ICP in a child?

A
  1. Headache - worse with straining, coughing, lying flat, leaning forward
  2. Bulging fontanelle
  3. Abnormal eye: U/L dilatation, Papilloedema
  4. Abnormal exam: tip-toe walking, ataxic gait, past-pointing
  5. Nausea + vomiting
  6. Decreased LoC - GCS and AVPU
17
Q

What is the management for a child with raised ICP?

A
  1. Urgent MRI/CT (identify if SOL)
  2. Diuretics (reduce CSF formation) - acetazolomide or furosemide
  3. Steroids
  4. Ventriculo-peritoneal shunt
18
Q

What are the two types of breath holding attacks?

A
  1. Blue breath holding attacks
    - triggered by intense sobbing or crying
    - baby stops breathing on exhalation –> syncope –> turns blue
  2. Reflex anoxic seizure
    - triggered by anger or being scared
    - baby tries to cry –> stops breathing on exhalation –> goes ghostly grey –> syncope –> limp and stiff –> eyes roll back
19
Q

What is the management of breath holding attacks

A

nothing

20
Q

What is setting sun eyes asign of?

A

Hydrocephalus

Other features are:

  • Macrocephaly
  • Distended head veins
  • Bulging fontanelle and sutures
  • signs of increased ICP
21
Q

What is the most common cause of retinal haemorrhage in infants?

A

Inflicted head injury caused by excessive shaking

22
Q

What are the types of plagiocephaly?

A
  1. Fully fused:
    Synostosis –> I/L flat forehead, C/L prominent forehead, C/L protruding orbit,
  2. Partial fused:
    minor plagiocephaly - typically occurs when babies lie on head
23
Q

What is a Tic? in whom is it most common?

A

A voluntary, unwanted movement that develops roughly around 6 years in males

24
Q

What are the features of a Tic?

A

Repetitive, unwanted movements or sounds (repeat the same tic)
Typically around face + head - grunting (common), blinking,, frowning, throat clearing, head flicking
Worse when inactive, stressed or anxious
Best when concentrating or playing sport

25
Q

A young 8 year old male, presents with myoclonic movements involving nods, blinks, twitching of mouth and verbal profanity. What is this?

A

Tourettes syndrome - clonic, tonic, dystonic, phonic tics usually -  Jerks  Blinks  Sniffs  Nods  Spitting  Stuttering  verbal profanity etc.

26
Q

What is the treatment of Tics?

A
  1. Behavioural management of child and parent

2. Medication: Risperidone or Clonidine

27
Q

What are the features of retinoblastoma and when does it commonly occur?

A

Starbismus (cross eyes)
Loss of red light reflex
Visual disturbances

Presentation at 18 months

Paediatrics (10 decks)

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