Paeds neuro + opthal Flashcards
(29 cards)
What are febrile convulsions?
Type of seizure that occurs in children with a high fever
What ages of children are affected by febrile convulsions?
6mths-5yrs
What kind of seizure are simple febrile convulsions?
Generalised, tonic clonic seizures lasting <15mins, only occur once during a single febrile illness.
What are complex febrile convulsions?
Described as complex when they consist of partial or focal seizures, last more than 15 minutes or occur multiple times during the same febrile illness.
Name 4 differentials for a febrile convulsion
Epilepsy
Meningitis
Intracranial space occupying lesions e.g. tumours
Trauma
What are the first steps in the Mx of a child w/ febrile convulsions?
Identify + manage source of infection
Give simple analgesia e.g. paracetamol/ibuprofen
Simple FC need no further investigations
What are 3 pieces of advice you would give to a parent on Mxing further eps of febrile convulsions
Stay w/ child
Put in recovery position in a safe place-pillows etc
Call ambulance if lasts more than 5mins
Are there any long-term complications of febrile convulsions?
No lasting damage
Marginally increased chance of developing epilepsy after simple FC (up to 18% higher chance if complex FC)
What are breath holding spells?
Involuntary episodes during which a child holds their breath, usually triggered by something upsetting or scaring them
What ages are breath holding spells most common in?
6-18mths
What is the long-term affect of breath holding spells?
No harm long-term, don’t lead to epilepsy, most children outgrow them by 4/5yrs
What are the 2 types of breath-holding spell?
Cyanotic breath holding spells
Pallid breath holding spells (aka reflex anoxic seizures)
When do cyanotic breath holding spells occur?
When the child is really upset, worked up and crying.
When do reflex anoxic seizures occur?
When a child is startled
What happens in cyanotic breath holding spell?
After letting out a long cry they stop breathing, become cyanotic and lose consciousness. Within a minute they regain consciousness and start breathing. They can be a bit tired and lethargic after an episode.
What happens in a reflex anoxic seizure?
The vagus nerve sends strong signals to the heart that causes it to stop beating. The child will suddenly go pale, lose consciousness and may start to have some seizure-like muscle twitching. Within 30 seconds the heart restarts and the child becomes conscious again.
How do you manage breath holding spells?
Exclude other pathology, make Dx, educate + reassure parents
Test for underlying cause of iron deficiency anaemia
What is a seizure?
Transient episodes of abnormal electrical activity in the brain.
What is epilepsy?
Disease of the brain with a tendency towards recurrent + unprovoked seizures
Name 5 types of epileptic seizure + brief description
Myoclonic-sudden muscle contraction e.g. jump
Tonic-clonic-loss of consciousness, tensing + jerking
Absence-blank, staring into space
Focal-start in temporal lobes, hallucinations, flashbacks, strange actions on autopilot
Atonic-drop attacks, brief lapse in muscle tone
What are infantile spasms (+ other name)?
AKA West syndrome
Characterised by clusters of full body spasms
Poor prognosis - 1/3 die by 25
What are 1st line Txs for infantile spasms?
Prednisolone
Vigabatrin
How do you investigate potential epilepsy?
EEG
MRI brain
Blood electrolytes
Blood glucose for hypoglycaemia
Blood cultures, urine culture + lumbar puncture for suspected sepsis/meningitis
Name 3 anti-epilpetics
*Sodium valproate-often 1st line, teratogenic
Lamotrigine-risk of stevens-johnson syndrome
Carbamazepine-for focal, risk of agranulocytosis
