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Pediatric Paroxysmal Events - Coggle Diagram
Pediatric Paroxysmal Events
Febrile vs Non-Febrile Seizures
Febrile Seizures
Key Features
Between 6 months to 6 years, lasts les than 15 months, generalized, +ve family history,
Breath Holding spells
Small periodic movements of the diaphragm, arterial O2 is decreased
Excessively compliant ribcage -> Allows collapse -> Stretch airways -> Simulate maximum lung volume -> Inhibition of inspiration
Reflex Syncope
Could be provoked by sudden fright of pain, gasp/cry, quiet looses consciousness and pale, limp, clonic movements
Periodic Syndromes
Benign paroxysmal Vertigo, cyclic vomiting, abdominal migraine, benign paroxysmal torticollis
Cardiogenic vs Neurogenic
Cardiogenic
Less frequent in children and higher mortality
Check for celiac disease, absence of pre-syncope premonitory symptoms, abrupt LOC during exercise
Neurocardiogenic
Prodromal Phase (Lightheadedness, blurred vision, epigastric discomfort, nausea, pallor, diaphoresis)
Syncope
Peripheral venous pooling -> Decreased venous return -> decreased ventricular filling -> mechanoreceptors -> Dorsal vagal nucleus -> Bradycardia vasodilation and hypotension
Management
Immediate Management
Roll to side of body, do not introduce anything into mouth, do not restrain limbs, rescue medications when seizures last longer than accepted
Approach
History
Circumstances, Signs and triggering factors, consciousness, movements, associated features, post-event period
Differential Diagnosis
Psychogenic
Frequent episodes not associated with injury, onset in supine position, fails to regain consciousness, remarkable indifference
Gratification Phenomena
Onset after the age of 3 months, before 3 years, sterotyped episodes, vocalizations, facial flushing, pressure on perineum, no alteration, cessation, normal examination, normal laboratory
Nocturnal Frontal Lobe epilepsy
Apparent full wakefulness, sudden, clear offset, hyperventilation, grunting respiration, dystonic stifferning posture, settling behaviours, rubbing nose or face