Pediatric neurology

1. Hari Shankar Meshram
Assistant Professor
Department of Pediatrics
CMMedical College

2. GOALS
a. Passing MBBS
b.Relationship goals
c. NEET
d.All of the above

3. Questions asked in exam
Acute flaccid paralysis
Approach to a child with seizure AND coma
Floppy baby
Tubercular meningits
Acute pyogenic meningitis
Febrile seizures
Hemiplegia
Duchenne muscular dystrophy
Tuberculoma
Neurocysticercosis

4. Something about relationship goals
its all neurology. No cardiology
involved Spectrum
Like
Infatuation
Attraction: dopamine
Crush : Nerve growth factor
Admire
Feelings
Lust : noradrenaline,dopamine
 Trust in partner:Serotonin
Attachment: oxytocin vasopressin
Love :All

5. 22

6. Most common cause of meningoencephalitis in
children is?
A. HSV
B. Measles
C. Arbobvirus
D. Enterovirus
D

7. STATUS EPILEPTICUS
SE was defined as 5 min or more of
(i) continuous clinical and/or electrographic seizure activity or
(ii) recurrent seizure activity
without recovery (returning to baseline) between seizures.
This definition was adopted for the following reasons:
• Most clinical and electrographic seizures last less than
5 min and seizures that last longer often do not stop spontaneously
Animal data suggest that permanent neuronal injury and
pharmacoresistance may occur before the traditional definition
of 30 min of continuous seizure activity have passed.
• More recently, experts have suggested a revised definition of SE
which includes seizures lasting for 5 min or longer.

10. Which one of the following is the most common cause of
congenital hydrocephalus?
A. Craniosynostosis
B. Intra uterine meningitis
C. Aqueductal stenosis
D. Malformations of great vein of Galen
C

11. Drug of choice for seizures in newborn
A. Phenytoin
B. Phenobarbitione
C. Valpraote
D. Carbamazepine
B

12. To be effective for preventing my elomeningocele,
administration of folic acid needs to begin?
1. By 3 months of gestation
2. At the first missed period
3. Before conception
4. By 30 days of gestation
5. At 3 months prior to delivery
3

13. Port wine stain
STURGE WEBER SYNDROME

14. Café au lait spots
What this neurocutaneous marker looks like

15. Ash leaf Macules
TUBEROUS SCLEROSIS

16. UFO unidentified bright objects in MRI is seen in
A.NF
B.TS
C.SWS
D.Meningitis
A

17. Most common tumour associated with
Neurofibromatosis I in children is?
A. AML
B. CML
C. ALL
D. JMML (Juvenile myelomonocytic leukemia)
D

18. A 10-year-old child with epilepsy since age 2 that is
refractory to medical treatment has been followed serially
with brain MRI scans, which show progressive atrophy of
the left hemisphere. What is the most likely diagnosis?
A. focal cortical dysplasia
B. neurofibromatosis
C. Rasmussen encephalitis
D. Sturge-Weber syndrome
E. tuberous sclerosis
C

19. An infant is born with hydrocephalus. CT studies demonstrate
herniation of the cerebellum into the spinal canal. This is an
example of which of the following?
A. Arnold-Chiari malformation
B. Dandy-Walker malformation
C. Holoprosencephaly
D. Lissencephaly
E. Porencephaly
A

20.  Mohd Atif 11 -month-old boy, complaints of some
strange episodes over the previous weeks. The
episodes usually occur soon after he has awaken &
sometimes before he goes to sleep.
 In these episodes his knees suddenly come up
towards his chest, arms bend at the elbows and
hands clench. Each episode lasts a few seconds but
they may occur repeatedly over many minutes.
 He become more irritable and has stopped showing
any interest in his toys.
 His birth and perinatal period were normal. There
is no family history of epilepsy.

21. Infantile spasms (West syndrome).
 Clinical Features
 EEG : hypsarrythmia
 Treatment : Vigabatrin & ACTH
 Associated with tuberous sclerosis

22. EEG IN INFANILE SPASMS

23. RAM2 yrs/M 10 kg presented in severe
dehydration with seizures & S.E. showed Na+ = 121
 Hyponatremic seizures
 Calculate the deficit from Adrogue Madias
Formulae :
Change in serum Na = {(infusate Na+infusate K)
- serum Na}
total body water + 1
TBW = 0.6 * body weight

24. CHINKI 4 yr girl presented with H/O cough ,cold & fever
for 2 days & 1 episode of seizures in form of GTCS
for 3 min., with no post ictal confusion , or postictal weakness

25. FEBRILE SEIZURES
Febrile seizures are the most common seizure
disorder in childhood, affecting 2 - 5% of children
between the ages of 6 months and 5 years

26.  Caused by the increase in the core body
temperature greater than 100.4F or 38C
 Threshold of temperature which may
trigger seizures is unique to each individual
 Can occur within the first 24 hours of an illness
Can be the first sign of illness in 25 - 50% of
patients

27. Febrile Seizure:
Characteristics
 Are benign
 Occurrence: between 6 months to 5 years of age
 May be either simple or complex type seizure
 Seizure accompanied by fever (before, during or after)
WITHOUT ANY
 Central nervous system infection
 Metabolic disturbance
 History of previous seizure disorder

28. Febrile Seizure: Two Types
Complex Febrile
 6 months – 5 years of age
 Febrile before, during or
after seizure
 Prolonged (lasting more
than 15 minutes)
 Focal seizure, or
 Occurs more than once in
24 hours
Simple Febrile
 6 months – 5 years of age
 Febrile before, during or
after seizure
 Seizure lasting less than
15 minutes
 Generalized seizure, and
 Occurs once in a 24-hour
period

29. Febrile Seizure: Management
 Complete physical exam – to identify the
source of fever
 Lab testing – direct toward identifying the
source of fever
For Simple Febrile Seizures: NO ROUTINE
LAB TESTS ARE NECESSARY

30. Simple Febrile Seizure:
Lumbar Puncture
Evidence-based recommendations from the
2011 American Academy of Pediatrics (AAP)
Subcommittee on Febrile Seizures7 are as
follows:
“A lumbar puncture should be performed in any child
who presents with a seizure and a fever and has
meningeal signs and symptoms (e.g., neck stiffness,
Kernig and/or Brudzinski signs) or in any child whose
history or examination suggests the presence of
meningitis or intracranial infection.”

31. Simple Febrile Seizure:
Family Education
Here are some frequently asked questions
parents/caregivers may have prior to discharge:
 Is my child brain damaged?
 There is no evidence of impact on learning abilities after seizure from
SFS.
 Will this happen again?
 If child is under 12 months of age at time of first seizure, recurrence rate
is 50%
 If child is greater than 12 months of age at time of first seizure,
recurrence rate is 30%
 Most recurrences occur within 6-12 months of the initial febrile seizure

32.  Will my child get epilepsy?
 For simple febrile seizures, there is no increased risk of epilepsy
 Why not treat for possible seizures or fever?
 Anticonvulsants can reduce recurrence. However potential side
effects of medications outweigh the minor risk of recurrence
 Prophylactic use of antipyretics does not have impact on recurrence

33. Shamim 10m / M presented with multiple seizures , child is
taking feeds in between normally ,Never had complaints of
fever or decreased activity HEAD circ. appears normal ,
Child was on cow milk .C
 His Ca + ionized came 0.4 mmol/L
 HYPOCALCEMIC SEIZURES

34. Treatment:
IV Calcium gluconate @ 80 -140 mg/kg /day through
continous infusion then taper in 3 days & shift to oral
IV Magnesium. 0.2/kg IM stat f/b 0.2 mg/kg OD for 3
days.
Send investigations according to need :
Phosphorus, Vit D, PTH, ALP

35. Di George Syndrome

36. Fawad 6 yrs/ M presented with fever for 1 month , seizures in form
of tonic posturing for 1 wk & altered sensorium since then .
CECT showed

37. Tubercular Meningitis
 1 yrs treatment 4 drug ATT for 2 months then 10
months 2 drug ATT
 In acute phase IV dexamethasone then shift to oral
prednisone fo r 6 weeks then taper in next 2 weeks
 Manage raised ICT in acute phase
 Anticonvulsant for 2 yrs

38. A 10 yrs child presented with SEIZURES tonic clonic of right
upper & lower limb . Child is afebrile & doesn't develops any
altered sensorium , BUT developed weakness which is
improving . CECT showed
TUBERCULOMA

39. TUBERCULOMA
 1 yrs ATT
 2 yrs anticonvulsant : TEGRITAL for partial
VALPARIN for generalized

40. A.Lissencephaly
B.Schizencephaly
C.Holoprosencephaly
D.Porencephaly
A

41. A.Lissencephaly
B.Schizencephaly
C.Holoprosencephaly
D.Porencephaly
C

42. A.Lissencephaly
B.Schizencephaly
C.Holoprosencephaly
D.Porencephaly
B

43. EDH SDH

44. A male baby weighing of 4.1 kg born through IDM
at term presented at NICU at 30 hrs of life with
complain of abnormal movement in form of tonic
movement of all four limbs . BS was 30 mg/dl
 HYPOGLYCEMIC SEIZURES

45.  TREATMENT
 If glucostix shows hypoglycemia or if there is no
facility to test blood sugar immediately,
 2 ml/kg of 10% dextrose should be given as a bolus
injection followed by a continuous infusion of 6-8
mg/kg/min.

46.  Sheela is a 6-year-old girl whose teachers noticed that
she seems to have problems listening and to be
daydreaming a lot in class.
 Now it seems to have been happening more frequently.
mother thinks that these daydreams or ‘trances’ as she
calls them sometimes occur when shee is in the middle of
doing or saying something, and they interrupt her
activity.
 Her birth and early medical history, including her
development, have been normal. There was a history of
epilepsy on her father’s side of the family.

47. ABSENCE seizures
 GTC seizures are unusual. Precipitation of seizure by
hyperventilation is a simple clinical diagnostic test
 An EEG showing a typical pattern characterized by
frontally predominant generalized bursts of 3 Hz spike
wave complexes with abrupt onset is diagnostic
 Valproate and ethosuxsimide followed by lamotrigine
and the benzodiazepines are the drugs of choice.

48. EEG IN ABSENCE SEIZURE

49. Giant panda sign in
Wilson Disease

50. Tiger eye in Hallervordon spatz
disease

51. A 8 yrs child presented with tonic clonic SEIZURES of LEFT
lowerlimb . Child is afebrile & does’nt develops any altered
sensorium , or weakness . CECT showed
NCC

52. NCC
 Cysticidal therapy for active lesion
 ALBENDAZOLE 15mg/kg /day for 5 - 28 days under
cover of steroid starting 2 -3 days before therapy
 Anticonvulsant for 6 -9 months or until resolution of
the lesion
 Calcified NCC needs anticonvulsant for 2 – 3 yrs

53. A baby 7 day old diagnosed as Preterm AGA with HIE stage
2 with refractory seizures on examination has AF full, and
poplieal angle restriction. What is the most likely
diagnosis

54. Intracranial Hemorrhage

55. Papile Grading in USG
and Volpe grading in mri
INTRAVENTRICULAR HEMORRHAGE
IN
NEWBORN

56. Steven johnson syndrome is associated with
A.lamotrigine
B. Valproate
c. Leveteriacetam
d. Phenytoin
A

57. NEET booster
Drug excretion maximum in breast milk
Levetericatem
And least in
Valporate

58.  A male chid 4 yrs pressented with developmental
regerssion for 5 months & for myoclonic jerks for 4
months .H/O measles was positive
 CSF MEASLES titre was positive
SSPE

59. Thanks
n
BEST OF LUCK