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• W2159522144 abstract "A child was born to nonconsanguineous, healthy parents. Pregnancy and delivery were uneventful, and psychomotor development was normal. At the age of 6 years and 10 months, he was admitted to a local hospital because of vomiting and nonfebrile unilateral headache. Neurologic examination had normal results. Blood tests (complete blood count, C-reactive protein, electrolytes, blood urea nitrogen, creatinine, glucose, serum bicarbonate and pH, anion gap, transaminase, and urine culture) were within normal limits. Abdominal x-ray and abdominal ultrasound imaging had normal results. Based on these results and on clinical observation, common medical and surgical causes (viral illness, gastroenteritis, diabetes, intestinal obstruction) were ruled out. Head CT scan had normal results. The EEG showed some irregular activity in the occipital regions, with rare sharp waves, more prevalent on the right side. One week later, a further awake EEG was performed and had normal results. A presumptive diagnosis of migraine with aura was made after 2 months by a pediatric neurologist because of several episodes of unilateral pulsatile headache and vomiting (one to two episodes per week). The episodes were preceded by a sensation of sickness, and lasted about 5–10 minutes each. Pallor, poorly defined abnormal ocular movements, and transitory unresponsiveness were also reported by his parents. After the episode, the child asked to sleep. Acetaminophen and ibuprofen were prescribed to control symptoms.Five months later, the patient was brought to the Emergency Department of our hospital because of recurrent and long-lasting episodes of headache beginning the same day. He had four episodes of nausea, vomiting, pallor, and unilateral (right-sided or left-sided) pulsatile headache, each one lasting from 5 to more than 30 minutes. The prescribed treatment was ineffective, and the child was considered to be in a migraine aura status by his pediatrician.A critical episode was observed during clinical examination: …" @default.
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• W2159522144 date "2009-04-13" @default.
• W2159522144 modified "2023-09-26" @default.
• W2159522144 title "Clinical Reasoning: A child with pulsatile headache and vomiting" @default.
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• W2159522144 doi "https://doi.org/10.1212/01.wnl.0000346690.84004.af" @default.
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