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Paroxysymal disorders in children (funny turns) (Blue 'breath…
Paroxysymal disorders
in children (funny turns)
Blue 'breath holding'
spells
Pathophysiology
Child cannot catch breath when crying, stuck in expiration, becomes hypoxic, hypotonic and may lose conciousness
Clinical presentation
Holds breath in expiration
Turns blue
May lose conciousness (briefly)
Epidemiology
Toddlers
Prognosis
Often resolve spontaneously
Management
Conservative: info, advice, support, watch and wait
Psychological: behavioural modification
Reflex asystolic
syncope
Pathophysiology
Triggered by head trauma, cold food, fright, pain, fever
Causes vagal inhibition and brief asystole thus hypoxia
Brief seizure, rapid recovery
Clinical presentation
Pallor
Falls to floor
Epidemiology
Infants and toddlers
Diagnosis
ECG and EEG - ocular compression triggers asystole and slow wave discharge
Syncope
Clinical presentation
Falls to floor
May have anoxic (non-epileptic) T-C seizure (secs)
Pathophysiology
Drop in BP and brain perfusion
Triggered by prolonged standing, hot/stuffy, fear
Epidemiology
Children
Migraine
Clinical presentation
Headache
Unsteadiness/lightheadedness
Visual aura
Abdominal pain (abdominal migraine)
Benign paroxysymal
vertigo (BPV)
Pathophysiology
Often primary headache disorder
May be triggered by viral labyrinthitis
Clinical presentation
Vertigo
Unsteadiness, falls
Nystagmus
NEAD
Pathophysiology
Functional seizures
Self
gratification
Pathophysiology
Genital stimulation for
a feeling of comfort
Arrhythmias
Pathophysiology
Prolonged QT syndrome
Cardiac syncope on exertion
Clinical presentation
Collapse
Daydreaming and
night terrrors
Fabrictated or
induced illness
Pathophysiology
Parent makes up or causes seizures
e.g. deliberate injection of insulin