Case 20: 7yo - Headaches Flashcards
Headaches: when would you admit? what would you do for mgmt?
- intractable vomiting (esp. when awakening) ==> head-occupying tumor [non-contrast head CT]
- complex migraine + focal weakness
- intractable pain
- URI ==> leading to fever == sinus abscess [contrast CT]
Other signs that this is NOT migraine/cluster/tension ==> and you should admit
- swelling
- fever / infectious signs
- bleeding
- dehydration ==> DVTs in the brain == HA +/- facial swelling
14yo female hiking in Muir woods,presenting with seizure in ER that lasted for 5 min, then stopped. 10min later had another.
hx of a HA in the past few days, then fever
sinus infection ==> abscess
Mgmt = CT with contrast
W/up for severe HA
1) CT = bleed, space occupying lesion, abscess
2) MRI = slow, insidious process
3) lumbar puncture = CSF, infectious markers
headaches that usually present outpatient
1) Migraine
2) Cluster
3) Tension
Describe: tension HA
- location
- timing
- severity
“band “
- trigger: stress
- location = around the hand +/- occipital and posterior neck muscles
- timing =episodic, worsens throughout the day
- severity = mild to moderate
Describe: migraine HA
- location
- timing
- severity
“throbbing”
- triggers: stress, bright lights, odors, foods
- location - UL or BL
- severity = SEVERE
+ sxs= photophobia and/or phonophobia, abd pain, N/V
+ FHx migraines
==> relieved with sleep
periodic migraine syndrome == atypical “migraine variant” seen in pediatric group
- cyclical vomiting
- abdominal migraines
- benign paroxysmal vertigo
most common cause of recurrent HA in children
migraine
what atypical migraine symptoms are usually seen exclusively in peds?
periodic migraine syndrome == atypical “migraine variant” seen in pediatric group
- cyclical vomiting
- abdominal migraines
- benign paroxysmal vertigo
“classic” migraine v. “common” migraine
“classic” migraine
- WITH aura / speech changes / sensory changes
“common” migraine
- WITHOUT aura; UL (frontal, temporal)
most common type of migraine HA in children?
“common” migraine
- WITHOUT aura; UL (frontal, temporal)
diffdx of a HA that occurs with forceful vomiting after lying down
early morning, after a nap
- migraine
- increased intracranial pressure
diffdx of a HA that occurs with sudden onset
- migraine
- intracranial hemorrhage
diffdx of a HA that occurs after awakening from a nap
- migraine
- increased intracranial pressure
diffdx of a HA accompanied by fever and photophobia
- migraine
- infectious (meningitis, encephailitis)
diffdx of a HA that worsens with cough / valsalva
- migraine
- increased ICP
diffdx of a HA that progressively worsens
- migraine
- slow-growing intracranial process
diffdx for a child: HA + fever and tachycardia
serious infection - meningitis
- encephalitis
- intracranial abscess
diffdx for a child: HA + hypertension, bradycardia, irregular respirations
== Cushing’s triad
increased intracranial pressure
what are some classic signs associated with allergies/
- allergic shiners
- allergic salute
- dennie’s lines
- cobblestoning
define: allergic shiners
darkness and swelling beneath the eyes due to sinus congestion
define: allergic salute
frequent upward rubbing of nose d/t itching ==> transverse nasal crease along the lower third of the nasal bridge
define: dennie’s lines
infraorbital transverse creases
+ mild chronic inflammation of the conjunctivae
define: cobblestoning
fine granular appearance of teh palpebral conjunctivae d/t edema & hyperplasia of the papillae
==> cobblestoning of the pharynx d/t chronic nasopharyngeal drainage of allergic rhinitis and lymphocytic hyperplasia
define: ataxia
- diffdx (acute v. chronic)
ataxia = lack of coordination of muscle movements
- patho = dysfunction in various parts of nervous system (cerebellum, inner ear, dorsal columns)
diffdx ACUTE - post-infectious cerebellitis - infectious cerebellitis -medication / toxin - opsoclonus-myoclonus syndrome - migraine HA - psychiatric illness
CHRONIC
- intracranial mass
- hydrocephalus
- metabolic dz
- neurodegenerative dz
post-infectious cerebellitis causing ataxia
- age group:
- timing
- patho:
- sxs
- dx
- prognosis
== acute cerebellar ataxia
[diagnosis of exclusion]
- age group: 1-3yo
- timing = several weeks after a viral infection
- patho: (varicella/coxsackie) autoimmune response ==> cerebellar demyelination
- sxs = sudden onset ==> + ataxia, vomiting, nystagmus OR dysarthria
- dx = CSF nml or pleocytosis; LATER CSF protein is elevated (NO fever, NO systemic changes)
- prognosis = most recover within a few months
infectious cerebellitis causing ataxia
- patho:
- sxs
acute ataxia
similar to bacterial meningitis
- patho: viral (mumps, enterovirus, EBV)/ bacterial (Strep pneumo, Neisseria meningitidis, H. influenza B)
- sxs = + mental status changes
medication / toxin causing ataxia
- etiology
- sxs
acute ataxia
meds = anticonvulsants, antihistamines
toxin = EtOH
- patho = diffuse involvement of cerebellum + vermis, cerebellar hemispheres
- sxs = + B/L nystagmus, dysmetria