Neurology

Steven, a 13-year-old boy, experienced his first headache at age 7 years. The frequency, intensity, and duration of his headaches have been increasing over the past 6 months. Steven now experiences 7 to 10 headaches each month that last up to 8 hours. The headaches are associated with mild nausea, light and sound sensitivity, dizziness, fatigue, occasional abdominal discomfort, and difficulty in concentrating. Last year, he had a vomiting episode because of a headache. The pain is usually more prominent in the forehead and does not favor either side of the head. The headaches usually begin in the morning before he leaves for school. As a result, Steven has missed nearly 25% of his school days this semester; his parents are considering home tutoring for "sick children who are unable to attend school."

You've been called down to the emergency department early this morning by the ED attending to see a 5-month-old girl brought in by her parents because of vomiting. The attending does not see signs of dehydration, but reports that the baby "looks funny."

"Headaches" is the chief complaint. Acne was the problem last year for 17-year-old Michelle. Otherwise her history is unremarkable. What's causing these daily headaches?

Traumatic brain injury affects virtually every aspect of the patient's-and family's-life. Here's what to expect in the aftermath and how to help the family deal with the often overwhelming demands of rehabilitation and return to home and community.

Knowing what signs and symptoms suggest intracranial pathology can help pediatricians approach the diagnosis of a brain tumor quickly and with confidence. As primary care physicians, they also play a key role in long-term management.