Headache is a common symptom in children and adolescents, with up to 75% experiencing a significant headache by age 15. Headaches can be primary, such as migraines or tension-type headaches, or secondary to other conditions such as viral infections. A thorough history and physical exam are usually sufficient for diagnosis, though imaging may be required if symptoms suggest increased intracranial pressure. Treatment involves acute medication to stop attacks as well as preventive medication and lifestyle modifications if headaches are frequent or disabling.
Headache in children -indexforpaediatrics.comdr-nagi
Headache is one of the commonest neurological symptoms in children and young people who are
referred to doctors. Headache refers to pain involving the orbits, forehead, scalp and temples but not
the face or neck. The primary headache includes chronic or recurrent headache and migraine. The
prevalence of chronic or recurrent headaches in children occur in 60-69% by the age of 7-9 years
and 75% by the age of 15 years. The prevalence of migraine in children is up to 28% of older
teenagers. The most serious cause of the secondary headache is brain tumor and the prevalence of
brain tumours in children is 3 per 100,000 per annum.
https://indexforpaediatrics.com
Headache in children -indexforpaediatrics.comdr-nagi
Headache is one of the commonest neurological symptoms in children and young people who are
referred to doctors. Headache refers to pain involving the orbits, forehead, scalp and temples but not
the face or neck. The primary headache includes chronic or recurrent headache and migraine. The
prevalence of chronic or recurrent headaches in children occur in 60-69% by the age of 7-9 years
and 75% by the age of 15 years. The prevalence of migraine in children is up to 28% of older
teenagers. The most serious cause of the secondary headache is brain tumor and the prevalence of
brain tumours in children is 3 per 100,000 per annum.
https://indexforpaediatrics.com
ATAXIA IN CHILDREN -CAUSES, MANAGEMENT, INVESTIGATIONS, TYPES, COMMONEST ATAXIA IN CHILDREN IN DETAIL, HOW WILL YOU FIND OUT THE CAUSE FOR ATAXIA IN CHILDREN FLOWCHART, DEFINITION, TREATMENT
Febrile convulsions are non-epileptic seizures that commonly occur in children between the age of 6-60 months, and are associated with a rapid rise in body temperature following an underlying condition. We discuss this in detail in the slides above, as well as with its management.
ATAXIA IN CHILDREN -CAUSES, MANAGEMENT, INVESTIGATIONS, TYPES, COMMONEST ATAXIA IN CHILDREN IN DETAIL, HOW WILL YOU FIND OUT THE CAUSE FOR ATAXIA IN CHILDREN FLOWCHART, DEFINITION, TREATMENT
Febrile convulsions are non-epileptic seizures that commonly occur in children between the age of 6-60 months, and are associated with a rapid rise in body temperature following an underlying condition. We discuss this in detail in the slides above, as well as with its management.
Seizure disorder is one of the important topic in children and adult also. here i explained the seizure disorder in pediatrics, include all most content for nurses level
Approach to patient with spinal cord lesions & diseases
Localize spinal cord lesions
Determining the Level of the Lesion in Myelopathy
Diseases of spinal cord
This is a comprehensive approach to a hypertensive patient presenting to the emergency department.
Discussing:-
- Hypertensive emergency
- Hypertensive Urgency
- Hypertensive Crisis
- Hypertensive encephalopathy and retinopathy
- Accelerated Hypertension
- Malignant hypertension
this is a complete discussion and an approach to a child with febrile seizure / convulsion.
It contains:-
Case scenario
Causes of Seizures in the setting of fever
Definition of Febrile Seizure
Age of Occurrence
Types of Febrile Convulsions
Risks of Recurrent Febrile Seizures
Risk For Developing Epilepsy After Febrile Seizures
Workup for Febrile Seizure
Red Flags in Febrile Seizures
Treatment
Prognosis
Approach to Syncope in Children (Pediatric Syncope).pptxJwan AlSofi
Approach to Syncope in Children (Pediatric Syncope), includes:-
Introduction
Differential diagnosis of syncope
Syncope vs vertigo vs Presyncope vs light-headedness.
Comparison of Clinical Features of Syncope and Seizures
Neurocardiogenic (Vasovagal) syncope
MECHANISMS and Causes of Syncope
Cardiac causes of syncope
Life-threatening causes of syncope
Red Flags in Evaluation of Patients With Syncope
Non-cardiac causes of loss of consciousness.
Noncardiac Causes of Syncope
Differentiating Features for Causes of Syncope
EVALUATION of syncope:- History, Examination,Treatment.
Summary
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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3. EPIDEMIOLOGY
3
• Headache is a common symptom among children and
adolescents.
• Up to 75% of children report having a significant
headache by the time they are 15 yr of age.
4. Cephalgia:-
• The International Classification of
Headache Disorders (ICHD)
defines headache as “pain located
above the orbitomeatal line
4
6. Headaches can be:-
1. a primary problem (migraines, tension-type headaches)
• Primary headaches are most often recurrent, episodic
headaches.
• For most children are sporadic in their presentation .
• frequent headaches can have an enormous impact on the
life of the child and adolescent .
2.secondary to another condition.
1. are most often associated with minor illnesses such as
viral upper respiratory infections or sinusitis
2. but may be the first symptom of serious conditions
(meningitis, brain tumors), so a systematic approach is
necessary .
6
7. Four temporal patterns of childhood
headache:-
1. Acute
2. Acute recurrent
3. Chronic progressive
4. Chronic nonprogressive or chronic daily
7
8. 1. Acute headache:-
• Single episode of pain without a history of such
episodes.
• The “first and worst” headache raises concerns for
aneurysmal subarachnoid hemorrhage in adults, but is
commonly due to febrile illness related to upper respiratory
tract infection in children.
• Regardless, more Ominous causes of acute headache
(hemorrhage, meningitis, tumor) must be considered.
8
9. 2. Acute recurrent headache:-
• Pattern of attacks of pain separated by symptom-free
intervals.
• Primary headache syndromes, such as migraine or tension-
type headache, usually cause this pattern.
• Recurrent headaches are occasionally due to
▫ specific epilepsy syndromes (benign occipital epilepsy),
▫ substance abuse,
▫ recurrent trauma.
9
10. 3.Chronic progressive headache:-
• Implies a gradually increasing frequency and severity
of headache.
• The pathological correlate is increasing ICP.
• Causes of this pattern include
1. pseudotumor cerebri,
2. brain tumor,
3. hydrocephalus,
4. chronic meningitis,
5. brain abscess
6. subdural collections.
10
11. 4. Chronic nonprogressive or
chronic daily :-
•Pattern of frequent or constant headache.
•Chronic daily headache generally is defined as >3-mo
history of >15 headaches/mo, with headaches lasting
>4 hr.
•Affected patients have normal neurological
examinations; psychological factors and anxiety
about possible underlying organic causes are common.
11
13. Points in history childhood headache:-
• Onset of headache (sudden onset)
• Duration of headache and frequency (daily, weekly, monthly)
• Location of headache (frontal, temporal, occipital)
• Severity of headache (mild, moderate, severe)
• Types of headache (one type or more than one type)
• Static or progressive frequency/severity of headache
• Associated nausea, vomiting
• Associated photophobia, phonophobia
• Relation to specific circumstances, food, medication
• Is child able to perform his/her activities despite headache
• Past medical history: minor head trauma, viral infection, surgery, stress
• History of drug intake (anticonvulsants, anticoagulants,asthma medication)
• History of school experiences, dietary habits and family relationships
• History of dental pain, nasal discharge, facial pain
• History of seizure, altered sensorium, vertigo, gait abnormality, weakness,
vision and hearing difficulties
• Family history of headache
13
14. Focused examination for children with headache:-
• General physical examination:
• Cervical spine examination
• Palpation of bones and muscles
• Ears including external auditory meatus
• Temporomandibular (TM) joint, throat, dental examination
• Examination of 9-12th cranial nerve
• Blood pressure measurement
• Height (short stature often point to endocrinal causes)
• Eye examination
• Sinus examination (Miller's maneuver)
• Evaluation of increased intracranial pressure
• Teeth inspection, palpation
• Cardiovascular system (CVS) examination: murmur,
• Any evidence of neurocutaneous markers
• Presence of organomegaly, lymphadenopathy
14
18. Tension-type headaches ( TTH )
18
• are the most common (48 % ) type of recurrent primary
headaches in children and adolescents.
• Because they are generally mild, without associated
symptoms, they typically do not disrupt daily activities.
19. 19
Analysis of the
Headache –
SOCRATES-
Tension-type headaches
Site Global
Character Squeezing or pressing – constriction band
Associated
Symptoms:-
• There is NO associated –
o Nausea
o Vomiting
o Phonophobia
o Photophobia
Timing Hours to days
Exacerbating
factors
1. Not aggravated by routine physical activity
2. Headaches can be related to environmental stresses or
symptomatic of underlying psychiatric illnesses, such as
anxiety or depression .
Severity Mild to moderate
21. Migraine headaches
21
• Migraine headaches are another common type of recurrent headaches.
• Frequently begin in childhood.
up to 10.6% between the ages of 5 and 15 yr.
up to 28% of older adolescents.
• Headaches are stereotyped attacks
• Toddlers may be unable to verbalize the source of their discomfort and exhibit
episodes of irritability, sleepiness, pallor, and vomiting.
• Types of Migraine:-
1. Migraine With Aura
2. Migraine Without Aura
3. Childhood periodic syndromes
4. Chronic migraine
22. 22
Analysis of the
Headache –
SOCRATES-
Migraine headaches
Site frontal, bitemporal or unilateral,
Character pounding or throbbing pain
Associated
Symptoms:-
1. Nausea
2. Vomiting
3. Pallor
4. Photophobia
5. Phonophobia
6. an intense desire to seek a quiet, dark room for rest.
Timing last 1-72 hours.
Exacerbating
factors
aggravated by activity
Severity moderate to severe,
24. • Migraine Without Aura
• Migraine without aura is the most common form of migraine in both children and adults.
• (at least five headaches that meet the criteria, typically over the past year
• Migraine With Aura ( At least 2 attacks )
• Aura a neurologic warning that a migraine is going to occur. (start of a typical migraine or isolated aura ).
• Typical aura : visual, sensory, or dysphasic
• Visual auras are very common and consist of spots, flashes, or lines of light that flicker in one or both
visual fields .
• The most common type of visual aura in children and adolescents is photopsia (flashes of light or light
bulbs going off everywhere).
• Atypical aura :
1. hemiparesis,
2. monocular blindness,
3. ophthalmoplegia,
4. Vertigo
5. confusion
• lasting longer than 5 min and less than 60 min
• the headache starting within 60 minutes
• unilateral
• reversible
2
4
28. Red flags (snoopy) indicates secondary headache:-
• Fever / weight loss / projectile vomiting
S –
systemic
• Focal neurological signs /meningeal signs /
papilledema / CN palsy
N –
neurological
S/S
• Sudden onset
• Onset during sleep
O –
onset
• Positional –
• During upright posture spontaneous intracranial hypotension
• During lying Idiopathic intracranial hypertension
• Precipitated by – Valsalva ↑ ICP
• Progressive
• Parents – lack of FMHx
P –
pattern
• Young age < 5-7 years
Y –
years
29. Secondary headaches
2
9
• Common causes :
1. viral illness
2. sinusitis
3. Medication-overuse headaches
4. Head trauma
• Serious causes :
• Increased intracranial pressure (ICP) caused by
• a mass (tumor, vascular malformation)
• intrinsic increase in pressure (pseudotumor cerebri )
30. Increased ICP should be suspected :
1. associated vomiting
2. worse when lying down or on first awakening
3. awaken the child from sleep
4. exacerbated by coughing, Valsalva maneuver, or bending over
5. Papilledema
6. focal neurological deficits
3
0
32. DIAGNOSTIC STUDIES
3
2
• For most children, a thorough history and physical examination
provide an accurate diagnosis and obviate the need for further testing.
• The history needs to include a thorough evaluation of the
1. prodromal symptoms,
2. any potential triggering events
3. timing of the headaches,
4. associated neurologic symptoms,
5. a detailed characterization of the headache attacks, including
I. frequency,
II. severity,
III. duration,
IV. associated symptoms,
V. use of medication
VI. disability.
33. Neuroimaging is usually not necessary.
Imaging is indicated if
1. symptoms of increased ICP,
2. there are unusual neurological features during the headache
(atypical aura),
3. the headaches are progressively worsening.
4. the patient has an abnormal neurological examination,
In these cases, brain MRI with and without gadolinium
contrast, is the study of choice, providing the highest sensitivity
for detecting posterior fossa lesions and other, more subtle
abnormalities.
3
3
34. When the headache has a sudden, severe onset, emergent CT
should be done.
Brain CT can quickly evaluate for intracranial bleeding.
If the CT is negative, a lumbar puncture should be performed
to
1. measure opening pressure
2. evaluate for pleocytosis,
3. elevated red blood cells
4. xanthochromia.
3
4
36. TREATMENT
3
6
• Secondary headache : depending on cause
• Tension-type headaches :
1. acute therapy to stop attacks,
2. preventive therapy when frequent or chronic
3. behavioral therapy
37. TREATMENT
3
7
• Migraine headaches :
1. acute treatment for stopping a headache attack with the
goal being 2 hr maximum
2. preventive treatment
3. biobehavioral therapy
38. • Symptomatic therapy requires early analgesic administration
• Acetaminophen or a NSAID such as ibuprofen or naproxen
sodium is often effective.
• rest in a quiet, dark room.
• Hydration and antiemetics are useful adjunctive therapies
3
8
39. • If these first-line medications are insufficient, triptan
agents (serotonin receptor agonists ) may be
considered.
• Triptans are contraindicated for patients with focal
neurological deficits associated with their migraines or
signs consistent with basilar migraine (syncope) because
of the risk of stroke .
3
9
40. • The limitation of any analgesic to not more than three
headaches a week is necessary to prevent the
transformation of the migraines into medication-
overuse headaches .
4
0
41. Prophylactic treatment
41
• Children with more than one disabling headache per
week may require daily preventive agents to reduce both
attack frequency and severity.
1. When the headaches are frequent (more than one
headache per week)
2. disabling (causing the patient to miss school, home, or
social activities,
44. lifestyle modifications must be put into place to
1. regulate sleep, daily routines
2. Exercise
3. to identify and eliminate any precipitating or
aggravating influences (caffeine, certain
foods, stress, missed meals, dehydration ).
4
4
45. Other adjunctive treatment options include
1. psychological support,
2. stress management
3. biofeedback.
4
5