Pediatric Neurology
Core concepts
Master the neurologic examination by age and the approach to seizures: febrile seizures (simple vs complex), epilepsy syndromes, and status epilepticus management (benzodiazepine first, then second-line). Understand headache red flags (morning vomiting, focal signs, papilledema) and when to image. Know meningitis/encephalitis presentation and the urgency of antibiotics and lumbar puncture (after stabilizing). Recognize cerebral palsy (nonprogressive motor disorder, risk factors, associated impairments) and developmental delay workup. Understand neuromuscular disorders (Duchenne muscular dystrophy: Gowers sign, calf pseudohypertrophy, elevated CK) and Guillain-Barré syndrome (ascending weakness, areflexia). Know hydrocephalus (increasing head circumference, sunset eyes) and neural tube defects (folate prevention).
Traps
- Missing status epilepticus because of under-dosing benzodiazepines.
- Performing lumbar puncture before stabilizing or in the presence of raised intracranial pressure.
- Confusing febrile seizure (common, benign) with epilepsy.
- Missing Duchenne because of normal early development; check CK in a boy with motor delay.
- Overlooking nonaccidental trauma in an infant with seizures or intracranial hemorrhage.
Worked example / rule of thumb
A 3-year-old with fever and a 2-minute generalized seizure: diagnose simple febrile seizure, reassure, and avoid routine imaging or EEG. Rule of thumb: status epilepticus = benzodiazepine first, repeat once, then second-line agent; a boy with motor delay and calf pseudohypertrophy = check CK for Duchenne.