Review Note
Last Update: 04/01/2024 02:31 AM
Current Deck: Neurology::Prior Rite Questions
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Text
A 2-year-old child is evaluated for brief episodes of vertigo during which he clutches his parent and looks frightened. Episodes gradually abate without treatment. Which of the following conditions is most likely to present in later childhood?
- complex partial seizures
- migraine without aura
- posterior fossa astrocytoma
- progressive ataxia with cardiomyopathy
- progressive hearing loss
Answer: {{c1::migraine without aura}}
Notes
The most likely condition to present in later childhood in a 2-year-old child evaluated for brief episodes of vertigo, during which he clutches his parent and looks frightened, with episodes that gradually abate without treatment, is benign paroxysmal vertigo, which is a type of episodic ataxia [1]. However, this condition is not listed among the answer choices. Therefore, we must consider the options provided in the context of the child's presentation and the typical age of onset for each condition.
- A. Complex partial seizures: While seizures can present with a variety of symptoms, including alterations in consciousness and motor control that could be mistaken for episodes of vertigo, the brief and self-limiting nature of the episodes described, along with the absence of other seizure-like features, makes complex partial seizures less likely.
- B. Migraine without aura: Migraine can present with vertigo, and children may not always have the classic headache associated with migraine. The episodic nature and the absence of headache in the vignette do not rule out this possibility. Migraine can begin in childhood and persist into adulthood [2].
- C. Posterior fossa astrocytoma: A posterior fossa tumor can cause ataxia and episodes of vertigo due to its location near the cerebellum and brainstem. However, these symptoms would likely be accompanied by other signs of increased intracranial pressure or focal neurological deficits, which are not described in the vignette [1].
- D. Progressive ataxia with cardiomyopathy: This condition would typically present with a progressive course rather than episodic symptoms, and the association with cardiomyopathy would likely manifest with additional cardiac symptoms, which are not mentioned in the vignette.
- E. Progressive hearing loss: Progressive hearing loss would not typically present with episodic vertigo in the absence of other auditory symptoms, such as hearing loss or tinnitus, and would not be expected to resolve spontaneously without treatment.
Given the options and the information provided, the most likely condition to present in later childhood that aligns with the child's symptoms is migraine without aura (B). Migraine in children can present with atypical symptoms, including episodic vertigo, and may not always be accompanied by headache. The episodes described are brief and self-limiting, which is consistent with the presentation of migraine in children
Pathophysiology Outline: Migraine is a neurological disorder characterized by recurrent episodes of headache, which can be accompanied by a variety of other symptoms such as nausea, vomiting, photophobia, phonophobia, and in some cases, vertigo. The pathophysiology of migraine involves a combination of genetic and environmental factors leading to alterations in neurotransmitter levels, cerebral blood flow, and neuronal excitability. Migraine attacks are thought to be initiated by a wave of cortical spreading depression, which can lead to the activation of the trigeminovascular system and subsequent release of inflammatory mediators, causing pain and associated symptoms.
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