Paediatric Neurology Flashcards
Cerebral palsy - state the following:
- Pathophysiology
- Investigations
- Management (MDT members involved in care)
Pathophysiology:
- Umbrella term for a permanent neuro-developmental problem (non-progressive condition) caused by damage to the brain tissue
- Huge variety in type and severity of symptoms
Investigations:
Typically clinically
- May need to rule out other conditions
- CT / MRI can help support diagnosis or identify another neurological cause
Management:
MDT approach
- Physical therapy / occupational therapy
- SALT team / dieticians
- Surgery
- Paediatrician for regular reviews
- Social workers
List some potential causes of cerebral palsy
- Antenatal
- Perinatal
- Post natal
Antenatal:
- Maternal infection
- Trauma during pregnancy
Perinatal:
- Hypoxia during birth
- Prematurity
Post natal:
- Meningitis
- Severe jaundice
- Head trauma
State some different types of cerebral palsy, for each type:
- which area of brain affected
- briefly describe presentation
Spastic:
- Damage to upper motor neurones
- Leading to hypertonia
Dyskinetic:
- Damage to the basal ganglia (initiate and control movements)
- Problems controlling muscle tone, with hypotonia and hypertonia
Ataxic:
- Damage to the cerebellum
- Leading to uncoordinated movements
Mixed:
- Mix of spastic, dyskinetic and ataxic features
State some patterns of cerebral palsy
Monoplegia: one limb affected
Hemiplegia: one side of body affected
Diplegia: all limbs affected, mostly legs
Quadriplegia: all limbs affected more severely, often with seizures, speech disturbance and other impairments
State some complications / associated conditions of cerebral palsy
- Learning disability
- Hearing and visual impairment
- Muscle contractures / difficulties moving
- Epilepsy
- Kyphoscoliosis
- GORD
For the following MDT members, suggest how they help in managing cerebral palsy
- Physical therapy / occupational therapy
- SALT team / dieticians
- Surgery
- Paediatrician for regular reviews
- Social workers
Physical therapy / occupational therapy:
- Stretch and strengthen muscles
- Maximise function
- Manage daily activities
SALT team / dieticians:
- Help if uncoordinated swallowing, may need NG or PEG
- Ensure that their dietary requirements are being met
Surgery:
- Release contracture (tenotomy)
Paediatricians:
- Regular reviews
- Medicines e.g. muscle relaxants, anti-epileptic drugs
Social workers:
- Social support
Febrile convulsions - state the following:
- Pathophysiology
- Most common age
- Presentation (including any red flags)
- Investigations
- Management
Pathophysiology:
- Subtype of seizure that occurs in children with a high fever
- No underlying neurological pathology or epilepsy
- Either simple febrile seizure or complex febrile seizure
Most common age:
- By definition, only occur between 6 months old and 5 years
Presentation:
- Simple or complex febrile seizure alongside a fever
- Tonic clonic pattern, either focal or generalised
- Can last < or > 15 minutes
Investigations:
Diagnosis of exclusion = need to rule out other pathology e.g. EEG, CT scan
Management:
Key: identify source of infection
- Control fever with Paracetamol and Ibuprofen
- Complex febrile seizures may require further investigations (simple generally reassurance)
Outline the difference between a simple febrile seizure and complex febrile seizure
Simple febrile seizure:
- Generalised
- Tonic clonic
- < 15 minutes in duration
- Only occur once during a period of high temp
Complex febrile seizure:
- Focal / partial
- > 15 minutes in duration
- Can occur multiple times during a period of high temp
State some differential diagnoses for febrile seizures
- Meningitis / encephalitis (other neurological infections)
- Epilepsy
- SOL or intracranial haemorrhage
- Syncopal episode
- Electrolyte disturbance
- Trauma / abuse
Suggest some advice which can be given to parents regarding further febrile seizures once child has been discharged
- Stay with child
- Lay them on the floor, pillow under their head, away from objects
- Don’t put anything in their mouth
- Call an ambulance if not stopped within 5 minutes
Outline the prognosis for febrile convulsions
Generally cause no lasting damage
Risk of developing epilepsy:
Normal population = 2%
- Simple febrile seizure = 2-7.5%
- Complex febrile seizure = 10-20%
Epilepsy - state the following:
- Pathophysiology
- Investigations
- Management
Pathophysiology:
- Umbrella term for tendency to have seizures
- Seizures are transient episodes of abnormal electrical brain activity
Investigations:
- EEG
- Consider MRI brain
- Consider to exclude other pathology e.g. ECG, blood glucose
Management:
- Generally safety advice to parents (including advice on status epilepticus)
- Anti-epileptics (ideally 1 drug)
Suggest some situations to be cautious of with patients with epilepsy
- Swimming
- Baths (showers suggested)
- At heights
- Traffic
- Driving if older
Outline how to manage status epilepticus
ABCDE approach
A - Secure airway
B - high flow oxygen
C - cannula, check cardiac and resp function
D - check glucose
E - x
IV Lorazepam, repeat after 10 mins if seizure continues
If persist, Phenytoin or Phenobarbitol
Then escalate to ITU with intubation
Suggest 2 drugs that can be used in the community for treatment epileptic seziures (before coming to hospital)
Buccal Midazolam
Rectal Diazepam
State different types of seizures
Generalised tonic-clonic:
- LOC
- Tense muscles (tonic)
- Jerking movements (clonic)
+/- tongue biting, incontinence, groaning
- Prolonged post-ictal period
Focal:
- Start in temporal lobes
- Issues with language, memory or emotions
- Hallucinations, deja vu, memory flashbacks
Absence:
- Patient becomes expressionless and unaware of surroundings
Atonic:
- Drop attacks, brief lapses in muscle tone
- Less than 3 minutes
Myoclonic:
- Brief muscle contractions
- Awake during attack
Infantile spasms (West syndrome):
Rare (poor prognosis)
- Clusters of full body spasms
- Starts around 6 months old
