Paediatrics & Child Health: Neurology

Presentations

• Abnormal head size
• Floppy baby
• Gait disturbances
• Headache
• Hearing loss
• Hypotonic infants
• Mimics of epileptic seizures:
  
  • breath holding attacks
  • non-epileptic seizures
  • syncope
• Neurological or developmental regression
• Numbness or altered sensation
• Seizures:
  
  • absence
  • afebrile
  • febrile
  • focal
  • generalised tonic–clonic
  • infantile gratification
  • myoclonic
  • neonatal
  • non-convulsive status epilepticus
  • status epilepticus
• Visual disturbance or abnormal eye movement
• Weakness

Conditions

• Bell’s palsy
• Central nervous system infections:
  
  • abscess
  • encephalitis
  • meningitis
• Cerebral palsy
• Duchenne muscular dystrophy
• Encephalopathy:
  
  • immune mediated
  • infectious
  • toxic
• Epilepsy
• Hydrocephalus
• Malformations of cerebral development
• Migraine
• Neurofibromatosis type 1 (NF1)
• Papilloedema
• Raised intracranial pressure
• Sensory disorders:
  
  • eye movement disorders:
    
    • nystagmus
    • strabismus
  • hearing impairment
  • visual impairment, including amblyopia
• Tension headache
• Traumatic brain injury:
  
  • accidental
  • inflicted

For each presentation and condition, Basic Trainees will know how to:

Synthesise

• recognise the clinical presentation
• identify relevant epidemiology, pathophysiology, and clinical science
• take a relevant clinical history
• conduct an appropriate examination
• establish a differential diagnosis
• plan and arrange appropriate investigations
• consider the impact of illness and disease on patients¹ and their quality of life

Manage

• provide evidence-based management
  For less common or more complex presentations and conditions the trainee must also seek expert opinions
• prescribe therapies tailored to patients’ needs and conditions
• recognise potential complications of disease and its management, and initiate preventative strategies
• involve multidisciplinary teams

Consider other factors

• identify individual and social factors and the impact of these on diagnosis and management

Presentations

• Acute flaccid paralysis
• Confusion

Conditions

• Central nervous system (CNS) inflammatory and immune mediated disorders:
  
  • acute disseminated encephalomyelitis (ADEM)
  • chronic inflammatory demyelinating polyneuropathy (CIDP)
  • Guillain–Barré syndrome
  • multiple sclerosis
  • N-methyl-D-aspartate receptor (NMDAR) encephalitis
  • transverse myelitis
• Central nervous system tumours
• Cerebellar disorders
• Cerebral venous sinus thrombosis
• Charcot–Marie–Tooth disease
• Congenital eye abnormalities:
  
  • cataract
  • coloboma
  • corneal opacification
  • ectopia lentis
  • septo-optic dysplasia
• Congenital myasthenic syndromes
• Demyelinating disorders
• Idiopathic intracranial hypertension
• Infantile spasms
• Motor neurone disorders
• Movement disorders, such as, ataxia, chorea, dystonia, functional movement
  disorders, paroxysmal movement disorders, tics, and tremor
• Muscular dystrophy
• Myasthenia gravis
• Myopathy, including metabolic, endocrine, and toxic
• Neural tube defects
• Neurocutaneous syndromes, such as:
  
  • hypomelanosis
  • neurofibromatosis type 2
  • Sturge–Weber syndrome
  • tuberous sclerosis
• Neurodegenerative disorders
• Neurological manifestations of systemic and chronic diseases, such as paraneoplastic disorders
• Paraneoplastic disorders
• Peripheral neuropathy:
  
  • acquired
  • hereditary
• Psychogenic neurological disorder
• Spinal cord compression
• Spinal muscular atrophy
• Stroke:
  
  • arterial ischaemic
  • haemorrhagic
  • venous sinus thrombosis

For each presentation and condition, Basic Trainees will know how to:

Synthesise

• recognise the clinical presentation
• identify relevant epidemiology, pathophysiology, and clinical science
• take a relevant clinical history
• conduct an appropriate examination
• establish a differential diagnosis
• plan and arrange appropriate investigations
• consider the impact of illness and disease on patients¹ and their quality of life

Manage

• provide evidence-based management
  For less common or more complex presentations and conditions the trainee must also seek expert opinions
• prescribe therapies tailored to patients’ needs and conditions
• recognise potential complications of disease and its management, and initiate preventative strategies
• involve multidisciplinary teams

Consider other factors

• identify individual and social factors and the impact of these on diagnosis and management

• Action of neurotransmitters and neurotransmission, including the autonomic nervous system (ANS)
• Anatomy and physiology of central and peripheral nervous system, including muscle and cerebral blood supply
• Concept of ‘brain death’
• Electrical activity of the brain and nerve conduction
• Metabolism of the brain
• Pharmacology of anticonvulsant medications
• Physiology of vision and hearing

Investigations

• Audiology (interpret audiogram and tympanogram plots)
• Electroencephalography (EEG)
• MRI brain and spine (identify gross abnormalities in images)

Procedures

• Lumbar puncture (interpret cell count, glucose, protein, and special stains)

Clinical assessment tools

• Eye examination finding interpretation in neurological disease:
  
  • eye movement assessment
  • fundoscopy
  • visual acuity
  • visual field testing

• Care needs of children with progressive neurological disorders
• Ethical principles involved in the care of dying patients
• Importance and meaning of resuscitation orders
• Mental health manifestations of systemic disease
• Needs of children with cerebral palsy
• Needs of family or carers of patients with neurological conditions, and the importance of assessing these needs
• Palliative care:
  
  • importance of respecting the wishes of family and carers
  • indications for referral to palliative care
  • recognising the dying phase
  • role of end-of-life care in certain clinical scenarios, such as fatal degenerative disorders
• Procedural safety in children with varying illness severity, such as during lumbar puncture
• Role of perfusion and metabolic imaging of the brain in the assessment of epilepsy
• Surgical options for treatment of epilepsy