Headaches Flashcards
Tension headaches
Result of stress (emotional, family, school)
- sore posterior neck muscles
- band around the head
- episodic
- mild to moderate quality
Migraines in kids
most common cause of recurrent headaches in kids
- cyclical vomiting, abdominal migraines, BBPV
- severe, throbbing, photophobia, N/V
- unilateral, frontal lobe
Precipitating and alleviating factors of migraines
Precip: stress, bright lights, odors, foods
Alleviate: sleep/medicine
Risk factors for migraines
family history
Classic vs common migraines
classic - associated with aura
common - no aura
Red Flags for headaches
Associated with projectile vomiting Sudden onset Accompanied by fever and photophobia Worsens with cough/valsalva Progressively worsening
Children with undue stress
May present with somatic complaints
- put it into context
Concerning vitals with a headache
Fever, tachycardia –> infections
Hypertension, bradycardia, irregular respirations –> cushings triad of ICP
Allergy findings
Allergic shiners –> bluish under eyes
Allergic salute –> upward wiping of nose
Dennies lines –> inflammation of conjunctiva
Cobblestoning –> appearance of conjunctiva from inflammation
Pseudotumor cerebri
pressure in brain increases for unknown reason –> absence of tumor or hydrocephalus
- headaches, diplopia, vomiting
- associated with obesity, metabolic disorders, meds, infections
Diagnosis of pseudotumor cerebri
normal anatomy
increased ICP
normal CSF
Headache diary
Character Duration Location Associated symptoms Activity Triggers Alleviating
Ataxia
lack of coordinated muscle movements
- nonspecific neuro signs suggestive a problem with cerebellum
DDx with ataxia
Infectious cerebellitis Post-infectious cerebellitis Toxin/med Tumor Opsoclonus/myoclonus syndrome Hydrocephalus Migraine Neurodegenerative disease Psychiatric Illness
Basilar migraine
bilateral visual disturbances, transient cortical blindness
- transient loss or impairment of consciousness
Nystagmus
rhythmic beating of the eyes
- sign of cerebellar disease (most prominent looking toward the side of disease)
Cerebellum
play important role in motor control (coordination, position)
- can lead to obstructive hydrocephalus
- Vermis (midline) –> truncal ataxia, dysarthia
- fall toward side of lesion and nystagmus toward lesion
- deep lesion –> resting tremor, myoclonus
Visualizing suspected brain tumors
MRI provides excellent views of posterior fossa
Distinguishing neuro exam findings
Infratentorial lesions - cerebellar signs and ICP
Supratentorial lesions - focal motor/sensory findings
Cerebellar hemispheric - changes in muscle tone and DTR
Brain stem tumors - CN palsies and gaze problems
Brain tumors in kids
2nd most common solid tumor –> incidence rising
Mortality decreasing –> morbidity high
Risk Factors for tumors
Ionizing radiation
Genetic conditions
Incidence by age
supratentorial
2-13 yrs –> infratentorial
adolescence and adulthood –> supratentorial
Brain stem gliomas
diffuse infiltration of pons
surgical resection required
prognosis very wide
Ependymomas
arise from 4th ventricle –> sx from hydrocephalus
surgical resection followed by radiation
Astrocytoma of cerebellum
best prognosis –> cystic component
surgical resection and possible radiation
Medulloblastoma
MOST COMMON PEDIATRIC BRAIN TUMOR
- can spread throughout CNS
- surgical resection, radiation, chemotherapy
Complications of brain tumors
Developmental and behavior problems
