Headache resident survival guide (pediatrics): Difference between revisions
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This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease. | This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease. | ||
<br /> | |||
==Causes== | ==Causes== | ||
===Life Threatening Causes=== | ===Life Threatening Causes=== | ||
| Line 31: | Line 38: | ||
*[[Subdural hematoma|Subdural Hematoma]] | *[[Subdural hematoma|Subdural Hematoma]] | ||
*[[Meningitis]] | *[[Meningitis]] | ||
*[[Encephalitis]] | |||
*[[Ventriculoperitoneal shunt]] | *[[Ventriculoperitoneal shunt]] | ||
*[[Brain abscess]] | |||
*[[Cerebral aneurysm]] | |||
*[[Increased intracranial pressure]] | |||
===Common Causes=== | ===Common Causes=== | ||
| Line 38: | Line 49: | ||
*[[Migraine]] | *[[Migraine]] | ||
*[[Headache - tension|Tension Headache]] | *[[Headache - tension|Tension Headache]] | ||
*[[Cluster headache|Trigeminal autonomic Cephalalgia (Cluster Headache)]] | *[[Cluster headache|Trigeminal autonomic Cephalalgia (Cluster Headache)]]. | ||
==FIRE: Focused Initial Rapid Evaluation== | ==FIRE: Focused Initial Rapid Evaluation== | ||
A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention. The initial rapid evaluation is based on the guidelines: | A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention. The initial rapid evaluation is based on the guidelines: | ||
[[Signs and Symptoms|Signs and symptom]] of a child with [[Brain tumor|brain tumor.]] These children will need urgent CNS imaging and referral to a Child Neurologist. | |||
* [[Headache]] Characteristics: | |||
** New [[Headache|persistant headache]] especially if for more than 4 weeks. | |||
** Change in nature of headache in previously diagnosed headache in children. | |||
** Symptoms like holding the [[head]] in children of age less than 4 years . | |||
* Persistent [[nausea]] and [[vomiting]] on waking up especially if going on for more than 2 weeks. | |||
* [[Eye examination]] | |||
** [[Papilledema|Papilloedema]] | |||
** [[Optic atrophy]] | |||
** [[Nystagmus|New onset nystagmus]] | |||
** [[Proptosis]] | |||
** [[Visual field|Visual field reduction]] | |||
** [[Strabismus|New onset paralytic non-comitant squint]] | |||
** [[Fundoscopy|Abnormal fundoscopy]] | |||
* CNS Examination | |||
** Motor signs | |||
*** A [[regression]] in [[motor skills]] | |||
*** Focal motor weakness | |||
*** [[Gait Abnormalities|Abnormal gait and/or coordination (unless local cause)]] | |||
*** [[Bell's palsy|Bell’s palsy]] ([[Lower motor neuron|isolated lower motor facial palsy]]) with no improvement within 4 weeks | |||
*** [[Dysphagia]] (unless local cause) | |||
*** In infants - Change in hand or foot preference | |||
*** Loss of learnt skills | |||
** [[Lethargy]] | |||
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*Attributing persistent nausea and vomiting to an infective cause in the absence of corroborative findings, eg, contact with similar illness, pyrexia, diarrhoea | *Attributing persistent nausea and vomiting to an infective cause in the absence of corroborative findings, eg, contact with similar illness, pyrexia, diarrhoea | ||
*Failure to fully assess vision in a young or uncooperative child | *Failure to fully assess vision in a young or uncooperative child | ||
* | *▶Failure of communication between community optometry and primary and secondary care | ||
*Attributing abnormal balance or gait to middle ear disease in the absence of corroborative findings | *Attributing abnormal balance or gait to middle ear disease in the absence of corroborative findings | ||
*Failure to identify swallowing difficulties as the cause of recurrent chest infections or “chestiness” | *Failure to identify swallowing difficulties as the cause of recurrent chest infections or “chestiness” | ||
*Attributing impaired growth with vomiting to gastrointestinal disease in the absence of corroborative findings | *Attributing impaired growth with vomiting to gastrointestinal disease in the absence of corroborative findings | ||
* | *Failure to consider diabetes insipidus in children with polyuria and polydipsia | ||
==References== | ==References== | ||
Revision as of 11:04, 1 August 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
| Headache resident survival guide (pediatrics) Microchapters |
|---|
| Overview |
| Causes |
| FIRE |
| Diagnosis |
| Treatment |
| Do's |
| Don'ts |
Overview
This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.
Causes
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
- Brain tumor
- Subdural Hematoma
- Meningitis
- Encephalitis
- Ventriculoperitoneal shunt
- Brain abscess
- Cerebral aneurysm
- Increased intracranial pressure
Common Causes
FIRE: Focused Initial Rapid Evaluation
A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention. The initial rapid evaluation is based on the guidelines:
Signs and symptom of a child with brain tumor. These children will need urgent CNS imaging and referral to a Child Neurologist.
- Headache Characteristics:
- New persistant headache especially if for more than 4 weeks.
- Change in nature of headache in previously diagnosed headache in children.
- Symptoms like holding the head in children of age less than 4 years .
- Persistent nausea and vomiting on waking up especially if going on for more than 2 weeks.
- Eye examination
- CNS Examination
- Motor signs
- A regression in motor skills
- Focal motor weakness
- Abnormal gait and/or coordination (unless local cause)
- Bell’s palsy (isolated lower motor facial palsy) with no improvement within 4 weeks
- Dysphagia (unless local cause)
- In infants - Change in hand or foot preference
- Loss of learnt skills
- Lethargy
- Motor signs
Complete Diagnostic Approach
Shown below is an algorithm summarizing the diagnosis of [[Headache]] according the the [...] guidelines.
Treatment
Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.
Do's
- The content in this section is in bullet points.
Don'ts
- Failure to reassess a child with migraine or tension headache when the headache character changes
- Attributing persistent nausea and vomiting to an infective cause in the absence of corroborative findings, eg, contact with similar illness, pyrexia, diarrhoea
- Failure to fully assess vision in a young or uncooperative child
- ▶Failure of communication between community optometry and primary and secondary care
- Attributing abnormal balance or gait to middle ear disease in the absence of corroborative findings
- Failure to identify swallowing difficulties as the cause of recurrent chest infections or “chestiness”
- Attributing impaired growth with vomiting to gastrointestinal disease in the absence of corroborative findings
- Failure to consider diabetes insipidus in children with polyuria and polydipsia