Neurocutaneous Signs in Children

What this deck covers

Neurocutaneous Signs in Children in twelve illustrated clinical cases with worked explanations – case presentations built around clinical images, radiology, teaching illustrations and real laboratory data, with the reference range beside every value a case quotes. This visual, data-interpretation style of practice suits candidates preparing for MRCPCH AKP in particular, alongside Saudi and Gulf licensing examinations such as the Arab Board, DHA and OMSB. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong.

The twelve cases, in order

1. Jerks in clusters, and pale patches nobody had noticed
2. Which drug, and what it costs
3. A mass in the heart at the twenty-week scan
4. Morning headache in a boy already under follow-up
5. Flank pain and a falling haemoglobin at fifteen
6. Treated for acne for a year
7. Unsteady since she started walking, and red eyes
8. Six brown patches, and breasts at four
9. A birthmark that covers most of the back
10. One leg longer, and stained since birth
11. A father who lost his sight, and a lesion in the retina
12. A streak down the scalp, and fits from one side

What this deck teaches

• The skin is the only visible part of the nervous system. A patch, a stain or a streak is neurological information that arrives years before the seizure, the tumour or the deficit, so it is examined rather than admired.
• Any infant with spasms gets an ultraviolet lamp. Ash-leaf macules are invisible in daylight and are the earliest skin sign of tuberous sclerosis, and three or more of them is a major criterion.
• Tuberous sclerosis is the exception that changes the first drug. Vigabatrin is first-line for spasms when the cause is tuberous sclerosis, at the cost of permanent peripheral field loss that a young child will not report.
• The signs of tuberous sclerosis arrive on a timetable. Rhabdomyomas antenatally, ash-leaf macules in infancy, angiofibromas and the shagreen patch in mid childhood, periungual fibromas near puberty. Assessed once is not cleared.
• The two tumours that are surveilled are the brain and the kidney. A giant cell astrocytoma obstructs at the foramen of Monro, and an angiomyolipoma above four centimetres bleeds. Renal disease is what kills in adult life.
• The border of a cafe-au-lait patch is half the criterion. Coast of Maine is jagged and stops at the midline, which is mosaic disease. Coast of California is smooth and crosses it. Counting six patches is not enough.

Exam pearls from this deck

• Any infant with spasms gets an ultraviolet lamp before the scanner.
• Tuberous sclerosis is the exception. Vigabatrin first, and say why.

The twelve worked cases in this deck, with the images and the full explanation of every option, are part of Pediatric Case Review membership. See what is included, or start with the free Pediatric Exam Review Sets.

More from this system: all neurology illustrated case decks · neurology board questions for bank-style drilling · the free Pediatric Exam Review Sets · pediatric reference values.