Paediatric Neurology

Question 1

What are examples of paediatric neurological pathologies?

Answer 1

• Congenital anomalies
• Neurogenetic diseases and syndromes
• Neurometabolic diseases and syndromes
• Acquired
  
  • Infection, ischaemia, trauma, tumour

Question 2

What is crucial from the history to determine differential diagnosis?

Answer 2

• Time course of symptoms crucial to determine differential diagnosis

Question 3

What should be asked about in the developmental history?

Answer 3

• Motor milestones
  
  • Gross and fine motor skills
• Speech and language development
• Early cognitive development
• Play
• Self-help skills
• Vision and hearing assessment

Question 4

What are important parts of the examination for neurological pathologies?

Answer 4

• Opportunistic approach
• Appearance
• Gait
• Head size
• Skin findings
• Real world examination (depends on age)

Question 5

What are some ‘common’ neurological conditions in children?

Answer 5

• Migraine
• Traumatic brain injury
• Tourette syndrome
• Epilepsy
• Brain tumours
  
  • Second most common cancer in children

Question 6

What are the different classifications of headache?

Answer 6

• Isolated acute
• Recurrent acute
• Chronic progressive
• Chronic non-progressive

Question 7

What should be asked when presenting complaint is headache?

Answer 7

• Typical episode
  
  • Any warning?
  • Location?
  • Severity?
  • Duration?
  • Frequency?

Question 8

What examinations should be done for headache?

Answer 8

• Growth parameters, OFC, BP
• Sinuses, teeth, visual acuity
• Funduscopy
• Visual fields (craniopharyngioma)
• Cranial bruit
• Focal neurological signs
• Cognitive and emotional status

Question 9

What are the 2 most common kinds of headache?

Answer 9

• Migraine
• Tension type headache

Question 10

What are features of migraine?

Answer 10

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

Question 11

Compare and contrast migraine and tension headache:

• pain distribution and character
• associated symptoms
• exacerbating/relieving factors
• FH

Answer 11

Question 12

What are red flag signs for:

• raised ICP
• analgesic overuse headache

Answer 12

Question 13

What are indications for neuroimaging for headache?

Answer 13

• Features of cerebellar dysfunction
• Features of raised intracranial pressure
• New focal neurological deficit
  
  • Such as new squint
• Seizures, especially focal
• Personality change
• Unexplained deterioration of school work

Question 14

Migraine - management

Answer 14

• Acute attack
  
  • Analgesia, triptans
• Prophylaxis
  
  • At least 1/week to justify
  • Drugs – Pizotifen, Propranolol, Amitryptyline, Topiramate, Valproate

Question 15

What drugs can be used for migraine:

• acute attack
• prophylaxsis

Answer 15

• Acute attack
  
  • Analgesia, triptans
• Prophylaxis
  
  • At least 1/week to justify
  • Drugs – Pizotifen, Propranolol, Amitryptyline, Topiramate, Valproate

Question 16

Tension type headache - management

Answer 16

• Reassurance, no sinister cause
• MDT management
• Attention to underlying chronic physical, psychological or emotional problems
• Acute attacks
  
  • Analgesia
• Prevention
  
  • Amitriptyline
• Discourage analgesics in chronic TTH