Neurology: Paroxysmal Disorders/ Funny Turns Flashcards
What is the key to diagnosis?
Detailed history
Review of video if available
Examination
Is there a broad differential diagnosis?
Yes
What are the key diagnostic questions?
Was it an epileptic seizure? And if so does the child have epilepsy?
What are blue breath holding spells?
Occur in some toddlers when upset
The child cries and holds its breath in expiration and goes blue
Sometimes children will briefly lose consciousness but rapidly recover fully
Drug therapy unhelpful
Attacks resolve spontaneously, but behaviour modification with distraction may help
What is another term for reflex asystolic syncope?
Reflex anoxic seizures
Describe reflex asystolic syncope
Occur in infants/toddlers
May have first degree relatives with history of faints
Commonest triggers: pain or discomfort- particularly from minor head trauma, cold food, fright or fever
After triggering event child becomes pale and falls to floor
The hypoxia can induce a generalised tonic clonic seizure - brief and rapid recovery
Due to cardiac asystole from vagal inhibition
Syncope (transient loss of consciousness) is another cause. What can cause it?
Hot environment
Standing for long periods
Fear
Clonic movements lasting a few seconds are common
What can migraines sometimes lead to?
Unsteadiness or light headedness
As well as the more common: GI disturbance
Can occur without headache
Benign paroxysmal vertigo can also cause ‘funny turns’. Describe what happens
Recurrent episodes of vertigo- 1 to several minutes
Nystagmus
Unsteadiness or falling
What other causes of funny turns are there?
Cardiac arrhythmia - prolonged QT May cause collapse
Self gratification
Pseudoseizures
Fabricated
Induced illness e.g seizure from hypoglycaemia from adult deliberately injecting insulin
Paroxysmal movement disorders
