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Paediatric Neuro Flashcards

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1
Q

What is cerebral palsy

A

A condition of permanent neurological problems resulting from damage to the brain around the time of brith

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2
Q

Are the symptoms of cerebral palsy progressive?

A

No however they may change over time with development

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3
Q

Causes of cerebral palsy

A

Birth asphyxia- hypoxic ischaemic encephalopathy
Maternal infections
Postnatal infections (e.g. meningitis, encephalitis)
Head injury

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4
Q

Types of cerebral palsy

A

Spastic
Dyskinetic
Ataxic
Mixed

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5
Q

Describe what spastic cerebral palsy is

A

Damage to the upper motor neurones leading to increased tone (spasticity) and brisk reflexes

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6
Q

What different types of spastic cerebral palsy are there?

A

Hemiplegia (unilateral involvement of arm and leg, usually the arm worse than leg)
Bilateral quadriplegia (all 4 limbs are affected, often severely)
Bilateral diplegia (all 4 limbs are affected however legs are much more severe than arms)

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7
Q

Explain dyskinetic cerebral palsy

A

Occurs due to damage of the basal ganglia and substantia nigra
Patients present with problems of muscle tone and movement - may include chorea, athetosis and dystonia
‘ slow writhing movements’

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8
Q

Explain ataxic cerebral palsy

A

Occurs due to damage to the cerebellum and often genetic.
Leads to uncoordinated movements

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9
Q

How may patient with cerebral palsy present?

A

Hemiplegic gait (due to increased muscle tone)
Delayed motor milestones
Feeding difficulties

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10
Q

Treatment approach of cerebral palsy

A

MDT
Physiotherapy
Muscle relaxants- baclofen

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11
Q

Describe the presentation of benign rolandic epilepsy

A

partial seizures at night- hemifacial paraesthesias, oropharyngeal and hypersalivation

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12
Q

when should an ambulance be called in patients with febrile convulsions

A

if lasting >5 misn

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13
Q

Treatment for spasticity in cerebral palsy

A

baclofen

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14
Q

What is a seizure

A

a paroxysmal abnormality of motor, sensory, autonomic and/or cognitive function due to transient brain dysfunction

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15
Q

Causes of epilepsy

A

genetic
structural
metabolic
cerebral malformation
cerebral tumours
cerebral tumours,

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16
Q

Causes of non-epileptic seizures

A

-cardiac syncope- e.g. prolonged QT
-neurally mediated syncope- e.g. reflex anoxic seizures
-expiratory apnoea syncope- breath holding spells
-hypovolaemic syncope- can occur in haemorrhagic, dehydration, anaphylaxis
-sudden rise in intracranial pressure (hydrocephalus, haemorrhage)
- sleep disorders
- functional/ medically unexplained/ dissociative seizures

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17
Q

How do focal frontal seizures present?

A

motor features such as posturing or peddling
Jaksonian march
motor arrest
post-ictal todds palsy
dysphagia or speech arrest

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18
Q

How do temporal lobe focal seizures present?

A

automatisms- lip smacking, chewing
dysphagia
deja vu
emotional disturbances (sudden terror)
hallucinations of smell, taste or sound

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19
Q

What is an absence seizure

A

transient loss of consciousness with abrupt onset and termination.
No accompanied motor phenomena except some eyelid flickering and minor alterations in muscle tone

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20
Q

What is a generalised seizures

A

electrical activity is discharged from both hemispheres of the brain
associated with a loss of consciousness

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21
Q

what is a focal seizure

A

seizures arise from one or part of a hemisphere
consciousness maintained

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22
Q

Treatment of tonic-clonic seizures

A

males- sodium valproate
females- lamotrigine or levetiracetam

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23
Q

treatment of absence seizures

A

1st line: ethosuximide
2nd line: sodium valproate (male), lamotrigine or levetiracetam (women)

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24
Q

what antiepileptic can exacerbate absence seizures

A

carbamazepine

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25
first line treatment of focal seizures
lamotrigine or levetiracetam
26
second line treatment of focal seizures
carbamazepine
27
What are infantile spasms
a type of epilespy syndrome which onsets 3-12 months Seizures are characterised by violent flexor spass of the head trunk and limbs followed by extension of the arms (Salaam attack). There will often be multiple bursts - 20-30
28
What does the EEG of infantile spasms show
hypsarrhythmia
29
How are infantile spasms treated
vigabatrin and/or corticosteroids
30
underlying aetiology of infantile spasms
often underlying serious neurological cause e.g. tuberous sclerosis, encephalitis
31
What is Lennox-Gastaut syndrome?
a type of epilepsy syndrome that presents around 1 to 3 years Can be an extension of infantile spasms Seizures are mainly atonic, atypical absence seizures and tonic seizures in sleep.
32
how does Lennox-Gastaut syndrome present on EEG
low generalised spike and wave
33
What is childhood absence epilespy
a type of paediatric epilepsy syndrome that presents around 4-12 years. Characterised by momentary unrresponsive stares with motor arrest which child cannot recall May be induced by hyperventilaiton treatment is ethosuximide good prognosis
34
What is benign rolandic epilepsy
an epilepsy syndrome that onsets at 4-10 years Characterised by tonic clonic seizures in sleep and simple focal seizures with awareness of abnormal feeling in the tongue and distortion of the face
35
How does juvenile myoclonic epilepsy present
myoclonic seizures, generalised tonic seizures and absence seizures. Often right after waking- history suggests throwing drinks or spilling things in the morning
36
How is epilepsy diagnosed?
detailed history- video if available ECG- checks for arrhythmias EEG Brain imaging- CT or MRI. checks for structural abnormalities, not needed if characteristic epilepsy syndrome (e.g. absence seizures) - metabolic investigations
37
what might trigger breath holding spells
emotional pain or upset
38
What is encephalitis
inflammation of the brain parenchyma- due to infectious or non-infectious cause
39
What is the most common cause of encephalitis
HSV infection in neonates HSV-2 acquired at birth is the most common cause in children HSV-1 from cold sores is the most common cause
40
What part of the brain does HSV most commonly affect?
the temporal lobe
41
What are two examples of autoimmune encephalitis
NDMA-receptor-antibody - associated encephalitis GABA-receptor- antibody encephalitis
42
how does encephalitis present in children ?
altered consciousness altered cognition unusual behaviour acute onset of neurological symptoms acute onset of focal seizures fever peripheral signs of HSV- cold sores HSV affecting the temporal lobe may cause aphasia
43
How does encephalitis present in neonates
poor feeding, irritability, seizures, lethargy, temperature instability
44
How is encephalitis in children diagnosed?
LP- viral PCR (not if raised ICP) - CT scan if LP is contraindicated
45
How is encephalitis treated
IV aciclovir if HSV or VZV ganciclovir in cytomegalovirus
46
what are the most common causes of meningitis in children under 3 months
Group B streptococcus Listeria monocytogenes E.coli
47
what are the most common causes of meningitis in children 3 months to 6 years
Strep. pneumoniae Neisseria meningitidis Haemophilus influenzae
48
What are the most common causes of meningitis in those over 6 years
neisseria meningitidis strep. pneumoniae
49
What are viral causes of meningitis
enteroviruses HSV HIV
50
How does meningitis present
fever headache neck stiffness purpuric non-blanching rash drowsiness nausea and vomiting seizures
51
how can meningitis present in babies
bulging fontanelles, reduced feeding, irritability, lethargy, unusual behaviour, high pitched weak cry
52
When would you not perform a LP for the investigation of meningitis ?
focal neurological signs papilledema significant bulging fontanelle disseminated intravascular coagulation signs of cerebral herniation
53
How does bacteria meningitis present on LP
polymorphs cloudy CSF low glucose high protein
54
how does viral meningitis present on LP
lymphocytes clear CSF glucose normal/ slightly low normal or raised protein
55
what is found in the CSF of TB meningitis
fibrin web
56
What should be done if a CSF is contraindicated in meningitis
blood cultures PCR
57
What is given to treat menginitis in community
IM benzylpenicillin
58
Treatment of meningitis in <3months
IV cefotaxime + IV amoxicillin/ampicillin
59
Treatment of meningitis in over 3 months
IV cefotaxime/ ceftriaxone
60
should you given steroids in the treatment of meningitis in someone under 3 months
no
61
what are some indications to give dexamethasone in meningitis
CSF is frankly purulent CSF WCC is > 100 per microlitre CSF has protein concentration > 1g/l CSF shows bacteria on gram stain
62
Overview of treatment of meningitis
- Broad spectrum anitbiotics (IV cefotaxime +/- IV amoxicillin) - consider dexamethasone in > 3months - fluids - notify public health england
63
what is given to contacts of meningitis
ciprofloxacin
64
Who is most commonly affected by febrile convulsions?
children under 3 (most common in under 6 months)
65
What are the two types of febrile convulsions?
simple and complex
66
describe simple febrile convulsions
primary generalised seizures lasting less than 15 mins, resolving spontaneously with complete recovery in <1 hour, and not recurring again within 24 hours
67
describe complex febrile convulsions
prolonged seizures (15-30 minutes) focal seizures recurrence within 24 hours or within the same illness
68
what defines febrile status epilepticus
>30 minutes
69
After what duration should parents phone 999 for a febrile convulsion and when should they administer rescue therapy
after 5 minutes
70
what might rescue therapy consist of for febrile convusions?
buccal midazolam or rectal diazepam
71
what factors increase the risk of having further febrile convulsions? (4)
age of onset less than 18 months occuring with temperatures < 39 shorter duration of fever before convulsion a family history
72
What RF for febrile convulsions increase the likelihood of having epilepsy?
family history of epilepsy complex febrile convulsions having a background of a neurodevelopmental disorder
73

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