Paediatric Neurology Flashcards by Laura I

types of pathology causing neurological issues in children

• Congenital
• Neurogenetic diseases and syndromes
• Neurometabolic diseases and syndromes
• Acquired
o Infection
o Ischaemia
o Trauma
o Tumour

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describe the neurologicl consultation in children

History taking: interactive
Hear what was said, not what you thought was said
Avoid quasi-medical language
Time course of symptoms crucial
Distinguishing static from slowly progressive symptoms can be challenging
Perinatal, developmental, family history

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describe a developmental hx

Motor milestones: gross and fine motor skills
Speech and language development
Early cognitive development
Play esp. symbolic play and social behaviour
Self-help skills
Vision and hearing assessment

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describe the neurological examination in children

Opportunistic approach and observation skills
Appearance
Gait
Head size
Skin findings
Real world examination (depends on age)
Synthesis of history and clinical findings into a differential diagnosis and investigation plan

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what % of hospitalised children have a neurological conditions

25%

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what percent of childre aged 10-17 have migraines?

7.7.%

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what are the first and second most common cancers in children?

leukaemia

brain tumours

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by age 7 and 15 what % of children have had a headache

40%

75%

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most parents who seek help for a child with a headache are looking for what?

reassurance that it is not due to a serious cause usually brain tumour

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4 ways to describe the onset of a headache

Isolated acute
Recurrent acute
Chronic progressive
Chronic non-progressive

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draw out the different types of headache in a child

see notes

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recurrent or chronic headache in children hx

Is there more than 1 type of headache?
Typical episode:
• Any warning
• Location
• Severity
• Duration
• Frequency

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headache examination in children

Growth parameters, OFC, BP
Sinuses, teeth, visual acuity
Fundoscopy
Visual fields (craniopharyngioma)
Cranial bruit
Focal neurological signs
Cognitive and emotional status
The diagnosis of headache aetiology is clinical

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pointers to childhood migraine

• Associated abdominal pain, nausea, vomiting
• Focal symptoms/ signs before, during, after attack: Visual disturbance, paraesthesia,
weakness
• ‘Pallor’
• Aggravated by bright light/ noise
• Relation to fatigue/ stress
• Helped by sleep/ rest/ dark, quiet room
• Family history often positive

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migraine vs tension headache

Migraine Tension Headache
Hemicranial pain Diffuse, symmetrical
Throbbing/pulsatile Band-like distribution
Abdo pain, N+V Present most of the time but there may be
symptom free periods
Relieved by rest Constant ache
Photophobia/phonophobia
Visual, sensory, motor aura
Positive family history

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features of raised intracranial pressure

Aggravated by activities that raise ICP e.g. coughing. Woken from sleep with headache

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features of analgesic overuse headache

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Headache is back before allowed to use another dose
Paracetamol/ NSAIDs
Particular problem with compound analgesics e.g. Cocodamol

indications for neuroimaging in children with headaches

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Features of cerebellar dysfunction
Features of raised intracranial pressure
New focal neurological deficit e.g. new squint
Seizures, esp. focal
Personality change
Unexplained deterioration of school work

management of migraine in children

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Acute attack: effective pain relief, triptans

* Preventative (at least 1/week): Pizotifen, Propranolol, Amitriptyline, Topiramate, Valproate

management of TTH in children

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Aim at reassurance: no sinister cause
Multidisciplinary management
Attention to underlying chronic physical, psychological or emotional problems
Acute attacks: simple analgesia
Prevention: Amitriptyline
Discourage analgesics in chronic TTH

define seizure/fit

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any sudden attack from whatever cause

define syncope

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faint - a neuro-cardiogenic mechanism

define convulsion

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seizure where there is prominent motor activity

define epileptic seizure

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an abnormal excessive hypersyncronous discharge from a group of usually cortical neurones

what do clinical features of an epileptic seiure depend on?

* Paroxysmal change in motor, sensory or cognitive function | * Depends on seizure’s location, degree of anatomical spread over cortex, duration

define epilepsy

a tendency to recurrent unprovoked epileptic seizures

examples of non-epileptic seizures in children

• Acute symptomatic seizures: due to acute insults e.g. Hypoxia-ischaemia, hypoglycemia, infection, trauma • Reflex anoxic seizure: common in toddlers • Syncope • Parasomnias e.g. night terrors • Behavioural stereotypies • Psychogenic seizures (NEAD)

define febrile convulsion

An event occurring in infancy/ childhood, usually between 3 months and 5 years of age, associated with fever but without evidence of intracranial infection or defined cause for the seizure

types of seizure

* Distinguishing seizure types can be challenging * Jerk/ shake: clonic, myoclonic, spasms * Stiff: usually a tonic seizure * Fall: Atonic/ tonic/ myoclonic * Vacant attack: absence, complex partial seizure

mechanism of an epileptic seizure

• Chemically triggered by: o Decreased inhibition (gamma-amino-butyric acid, GABA) o Excessive excitation (glutamate and aspartate) o Excessive influx of Na and Ca ions • 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)

childhood vs adult onset epilepsies

* Majority are idiopathic in origin (both Focal & Generalised) * Majority of epilepsies are generalised * Seizures can be subtle (absences, myoclonus, drop attacks)

why can a diagnosis of epilepsy be difficult?

o Non-epileptic paroxysmal disorders are more common in children o Difficulty in explaining (Children are not young adults) o Difficulty in interpretation (witness) o Difficulty in interpretation and synthesising information(physician

stepwise approach to a diagnosis of epilepsy

* Is the paroxysmal event epileptic in nature? * Is it epilepsy? * What seizure types are occurring? * What is the epilepsy syndrome? * What is the aetiology? * What are the social and educational effects on the child?

role of the EEG in epilepsy

* An interictal EEG has limited value in deciding when the individual has epilepsy * Sensitivity of first routine interictal EEG: 30- 60% * Problematic false positive rates: paroxysmal activity seen in 30%, frankly epileptiform activity in 5% of normal children * Useful in identifying seizure types, seizure syndrome and aetiology

diagnosis of epilepsy in children

• History • Video recording of event • ECG in convulsive seizures • Interictal/ ictal EEG • MRI Brain: to determine aetiology e.g. Brain malformations/ brain damage • Genetics: idiopathic epilepsies are mostly familial; also, single gene disorders e.g. Tuberous sclerosis • Metabolic tests: esp. if associated with developmental delay/ regression

management of epilepsy in children

• Anti-epileptic drugs (AED) should only be considered if diagnosis is clear even if this means delaying treatment • Role of AED is to control seizures, not cure the epilepsy • Start with one AED: slow upward titration until side-effects manifest or drug is considered to be inefficient. • Age, gender, type of seizures and epilepsy should be considered in selecting AEDs • S/Es: CNS related can be detrimental; Drowsiness, effect on learning, cognition and behavioural • Sodium Valproate: first line for generalised epilepsies (not in girls- recent MHRA advice) • Carbamazepine: first line for focal epilepsies • Several new AEDs with more tolerability and fewer side effects: Levetiracetam, Lamotrigine, Perampanel • Other therapies: steroids, immunoglobulins and ketogenic diet (mostly for resistant epilepsies)

when to suspect a neuromuscular disorder

* Baby ‘floppy’ from birth * Slips from hands * Paucity of limb movements * Alert, but less motor activity * Delayed motor milestones * Able to walk but frequent falls

types of neuromuscular disorders

* Muscle: muscular dystrophies, myopathies- congenital and inflammatory, myotonic syndromes * Neuromuscular junction: myasthenic syndromes * Nerve: Hereditary or acquired neuropathies * Anterior Horn Cell: Spinal muscular atrophy

DMD: gene

Xp21, dystrophin gene

DMD: signs

``` • Delayed gross motor skills • Symmetrical proximal weakness o Waddling gait, calf hypertrophy o Gower’s sign positive • Elevated Creatinine Kinase levels o >1000 in DMD • Cardiomyopathy • Respiratory involvement in teens ```

Paediatric Neurology Flashcards

(40 cards)