Pediatrics
Central Nervous System Disorders
Paediatric neurology for NEET-PG: meningitis, febrile seizures, status epilepticus, cerebral palsy and CSF interpretation, mapped to NMC PE30 codes.
MedNext Academy | 3 min read
Central Nervous System Disorders
Paediatric neurology for NEET-PG: meningitis, febrile seizures, status epilepticus, cerebral palsy and CSF interpretation, mapped to NMC PE30 codes.
This chapter covers paediatric neurology, from meningitis, hydrocephalus and neural tube defects through febrile seizures, epilepsy and status epilepticus to cerebral palsy, the floppy infant, Duchenne muscular dystrophy and the interpretation of CSF and neuroimaging. It stresses safe lumbar puncture and the Indian ring-enhancing lesion differential.
High-yield: Central Nervous System Disorders
- Meningitis is an emergency diagnosis: a toxic infant does not need neck stiffness before treatment, and the key decision is whether lumbar puncture is safe.
- Shock, papilledema, focal deficit, abnormal posturing or impending herniation means stabilise and treat before lumbar puncture.
- Bacterial meningitis is acute, toxic, neutrophilic with low glucose; viral is usually lymphocytic with normal glucose; and tuberculous meningitis is subacute with basal complications and low glucose.
- Cerebrospinal fluid glucose is compared with simultaneous blood glucose, and a value below about 40 percent of blood glucose supports bacterial, tuberculous or fungal disease.
- In infants, serial head circumference crossing centiles matters more than a single large head, and sunset eyes, a tense fontanelle and vomiting make hydrocephalus urgent.
- Neural tube closure completes by about day 28 after conception, so prevention is preconceptional folic acid 0.4 mg daily for low-risk women and 4 mg daily after a previous affected pregnancy.
- A simple febrile seizure is generalised, under 15 minutes, once in 24 hours and followed by complete recovery in a developmentally normal child aged 6 to 60 months.
- Routine EEG, CT, calcium testing and daily antiseizure prophylaxis are wrong after a typical recovered simple febrile seizure.
- Convulsive status epilepticus is treated operationally at 5 minutes with airway, oxygen, glucose, a benzodiazepine and a timely second-line drug, avoiding repeated benzodiazepine dosing.
- Developmental regression, the loss of acquired milestones, is always a red flag and prompts a search for treatable causes such as hypothyroidism, B12 deficiency and metabolic disease.
- Cerebral palsy is permanent and non-progressive, so regression, new weakness or progressive swallowing difficulty is not cerebral palsy until alternative diagnoses are excluded.
- Duchenne muscular dystrophy is an X-linked dystrophinopathy with delayed running, a Gower sign, calf pseudohypertrophy and a very high creatine kinase, with cardiac and respiratory surveillance driving mortality.
- Poliomyelitis causes asymmetric flaccid weakness with reduced reflexes and preserved sensation, and acute flaccid paralysis surveillance is a public-health obligation even in a polio-free country.
- Ring-enhancing lesions in Indian children require a ranked differential of neurocysticercosis, tuberculoma, abscess, fungal infection, demyelination and tumour rather than a single reflex answer.
- A normal EEG does not exclude epilepsy and a normal early CT does not exclude stroke or encephalitis.
Meningitis CSF patterns
- **Bacterial:** Acute, toxic, neutrophilic, low glucose (below about 40 percent of blood glucose).
- **Viral:** Usually lymphocytic with normal glucose.
- **Tuberculous:** Subacute, lymphocytic, low glucose with basal complications and hydrocephalus.
- **Unsafe LP:** Shock, papilledema, focal deficit or herniation signs mean stabilise and treat first.
NMC competencies in this chapter
- **PE30.1:** Meningitis in Children
- **PE30.5:** Neural Tube Defects
- **PE30.7:** Febrile Seizures
- **PE30.9:** Status Epilepticus
- **PE30.11:** Cerebral Palsy
- **PE30.14:** Duchenne Muscular Dystrophy
- **PE30.20:** Cerebrospinal Fluid Analysis
Frequently Asked Questions
How do CSF patterns differ across meningitis types?
Bacterial meningitis is acute, neutrophilic with low glucose; viral is usually lymphocytic with normal glucose; and tuberculous meningitis is subacute with basal complications and low glucose. CSF glucose is compared with simultaneous blood glucose.
What defines a simple febrile seizure?
It is generalised, lasts under 15 minutes, occurs once in 24 hours and is followed by complete recovery in a developmentally normal child aged 6 to 60 months. Routine EEG, CT, calcium testing and daily prophylaxis are not indicated after a typical simple event.
How is neural tube defect prevention dosed?
Neural tube closure completes by about day 28 after conception, so folic acid is preconceptional: 0.4 mg daily for low-risk women and 4 mg daily for a woman with a previous affected pregnancy, under obstetric supervision.
Why is developmental regression always a red flag?
Regression is the loss of previously acquired milestones and always warrants a search for treatable causes such as hypothyroidism, vitamin B12 deficiency, epilepsy syndromes, hydrocephalus, lead poisoning and metabolic disease.
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