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paediatric neurology Flashcards

(59 cards)

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1
Q

clinical evaluation of childhood headache disorders

A

isolated acute
recurrent acute
chronic progressive
chronic non-progressive

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2
Q

pointers to childhood migraine

A
  • assoc abdo pain, nausea, vomiting
  • focal symptoms/signs before, during, after attack: visual disturbance, paresthesia, weakness
  • pallor
  • aggravated by light/noise
  • relation to fatigue/stress
  • helped by sleep, rest, dark, quiet
  • FH often positive
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3
Q

features of tension type headahce

A

diffuse, symmetrical
band-like distribution
present most of time
contant ache

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4
Q

features of migraine

A 
hemicranial pain 
throb/pulsatile
abdo pain, nausea, vomit
relieved by rest 
photo/phono-phobia
visual, sensory, motor aura
FH
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5
Q

pointers to raised intracranial pressure

A

aggravated by activities that raise ICP e.g. coughing, bending

woken from sleep with headache +/- vomiting

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6
Q

pointers to analgesic overuse headache

A

headache is back before allowed to use another dose

paracetamol/NSAIDs

partic problem with compound analgesics e.g. cocodamol

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7
Q

indications for neuroimaging

A
  • features of cerebellar dysfunction
  • features of raised ICP
  • new focal neurological deficit e.g. new squint
  • seizures, esp focal
  • personality change
  • unexplained deterioration of school work
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8
Q

migraine management

A

acute attack: effective pain relief, triptans

preventative (at least 1wk): pizotifen, propranolol, amitryptyline, topiramate, valproate

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9
Q

tension type headache treatment

A
  • reassurance: no sinister cause
  • attention to underlying physical, psychological, emotional problems

acute attacks: simple analgesia

prevention: amitryptiline

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10
Q

seizure/fit

A

any sudden attack from whatever cause

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11
Q

syncope

A

faint - a neuro-cardiogenic mechanism

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12
Q

convulsion

A

seizure where there is prominent motor activity

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13
Q

epileptic seizure

A

an electrical phenomenon

an abnormal excessive hyper-synchronous discharge from a group of cortical neurons

paroxysmal change in motor, sensory or cognitive function

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14
Q

what does seizure manifestation depend on

A

seizure location
degree of anatomical spread over cortex
duration - of abnormal electrical discharge

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15
Q

epilepsy

A

a tendency to recurrent, unprovoked (spontaneous) epileptic seizures

EEG for supportive evidence - single epileptic seizure doesn’t mean they have epilepsy

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16
Q

non-epileptic seizures and other mimics in children

A
  • acute symptomatic seizures
  • reflex anoxic seizure
  • syncope
  • parasomnias e.g. night terror
  • behavioural stereotypies
  • psychogenic non-epileptic seizure
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17
Q

acute symptomatic seizures

A

due to acute insults to brain e.g. hypoxia-ischaemia, hypoglycaemia, trauma, infection

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18
Q

reflex anoxic seizures

A

vagal overstimulation, always provoked/triggered by certain stimuli

common in toddlers

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19
Q

febrile convulsion

A

seizure occurring usually between 3mo and 5yrs, assoc with fever but without evidence of intracranial infection or defined cause of seizure

commonest cause of acute symptomatic seizure in childhood

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20
Q

what is an epileptic fit chemically triggered by

A

decreased inhibition (gama-amino-butyric acid, GABA)

excessive excitation (glutamate and aspartate)

excessive influx of Na and Ca ions

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21
Q

mechanism of epileptic fit

A

triggered by imbalance between excitatory and inhibitory neurones

chemical stimulation produces an electrical current

summation of a multitude of electrical potentials results in depolarisation of many neurones which can lead to seizures, can be recorded from surface electrodes (electroencephalogram)

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22
Q

types of epileptic seizures

A

partial/focal seizures

generalised seizures

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23
Q

partial/focal seizures

A

seizure focus restricted to 1 hemisphere/part of one hemisphere

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24
Q

generalised seizure

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A

neurones recruited from both halves of brain - both hemispheres involved

25
childhood vs adult onset epilepsies
majority generalised majority idiopathic seizures subtle in childhood - can be missed by parents/carers diagnosis challenging - large no paroxysmal evens in kids, difficulty getting good history
26
stepwise approach to diagnosing epilepsy
- is the paroxysmal event epileptic in nature? - is it epilepy? - what type of seizures are occuring? - what is the epilepsy syndrome? - what is the aetiology? - what are the social and educational effects on the child?
27
role of the EEG
-limited value in deciding when the pt has epilepsy role in assessing and managing diagnosed epilepsy. useful in identifying seizure types, seizure syndrome and aetiology
28
diagnosing epilepsy
history video of event ECG in convulsive events (rule out long QT syndrome) EEG MRI brain - aetiology genetics metabolic tests - esp if assoc with developmental delay/regression
29
management of epilepsies in children
anti-epileptic drugs is diagnosis clear, they control seizures - not a cure start with 1 AED and slow upward titration until side-effects manifest or drug considered inefficient
30
drug treatment of epilepsy
generalised epilepsies: sodium valproate (not for girls) or levetiracetam focal epilepsies: carbamazepine other: steroids, immunoglobulines, ketogenic diet (for drug-resistant epilepsies)
31
epilepsy management: surgery
vagal nerve stimulator resection
32
head size problems
macrocephaly | microcephaly
33
in infant skull: what suture holds the frontal bones together
metopic suture
34
in infant skull: what suture holds parietal bones together
sagittal suture
35
in infant skull: why are sutures open
to allow brain to grow
36
order in which fontanelles close
posterior fontanelle usually closes 2-3mo after birth gradual fusion of sutures anterior fontanelle usually closed between 1-3yoa (avg 18mo)
37
when is OFC measured
routine between birth-3yrs should be interpreted of rest of family - measure parents to see if kid is inkeeping with rest of family
38
microcephaly definition
mild: OFC <2 standard deviations below mean moderate/severe: OFC < 3 SD
39
what does microcephaly indicate
usually indicates small brain 'micranencephaly'
40
causes of microcephaly
antenatal postnatal genetic environment
41
macrocephaly definition
OFC > 2SD
42
macrocephaly: what is indicated if they're crossing centiles upwards
underlying brain or CSF is expanding in a way it shouldn't
43
plagiocephaly
flat head - usually one one side
44
brachycephaly
short head which is also flat at back
45
scaphocephaly
head with unusual boat shape
46
craniosynostosis
premature fusion of cranial sutures if they fuse too quickly brain has no room to grow and may end up with very odd head shape
47
what direction to skull bones normally grow
perpendicular to the sutures
48
deformational plagiocephaly
most common reason for abnormal head shape to do with the position child is in e..g how they sleep, lie
49
when to suspect a neuromuscular disorder
``` baby floppy from birth slips from your hands paucity of limb movements alert but less motor activity delayed motor milestones able to walk but frequent falls ```
50
duchenne muscular dystrophy: genetics
Xp21, dystrophin gene male infants x-linked
51
duchenne muscular dystrophy: presentation
``` delayed gross motor skills symmetrical proximal weakness Gower's sign positive waddling gait cardiomyopathy respiratory involvement in teens ``` elevated creatinine kinase levels
52
anatomical approach to neuromuscular conditions: muscle
muscular dystrophies myopathies - congenital and inflammatory myotonic syndromes
53
anatomical approach to neuromuscular conditions: neuromuscular junction
myasthenic syndrome
54
anatomical approach to neuromuscular conditions: nerve
hereditary or acquired neuropathies
55
anatomical approach to neuromuscular conditions: anterior horn cell
spinal muscular atrophy
56
myotonia
inability for muscle to relax after contraction - sustained muscle contraction
57
simple vs complex febrile seizure
simple <10mins, generalised, doesn't reccur in 24hrs complex >10/15mins, focal, recurs within 24hrs
58
treatment complex febrile seizure
rectal diazepam | buccal midazolam
59
features febrile seizure
``` 6mo-5yrs assoc fever generalised tonic clonic 3-6mins recover within an hour ```

paediatrics (68 decks)

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