Table Of Content

Symptom-Based Approach to Pediatric Neurology Deepak M. Kamat Lalitha Sivaswamy Editors 123 Symptom-Based Approach to Pediatric Neurology Deepak M. Kamat • Lalitha Sivaswamy Editors Symptom-Based Approach to Pediatric Neurology Editors Deepak M. Kamat Lalitha Sivaswamy Department of Pediatrics Pediatrics and Neurology University of Texas Health Science Center Central Michigan University San Antonio, TX, USA Children’s Hospital of Michigan Detroit, MI, USA ISBN 978-3-031-10493-0 ISBN 978-3-031-10494-7 (eBook) https://doi.org/10.1007/978-3-031-10494-7 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Preface The brain and its connections unarguably constitute the most complex of all human organ systems. While an adult brain weighs a little over a kilogram, it houses over 85 billion neurons and contains miles of axons. It can generate complex emotions, allows us to imagine, strategize, and carry out a myriad of functions, and controls every aspect of our awake or sleeping life. Given the complexity of the nervous system, it is natural that symptoms that refer to the central or peripheral nervous system can lead to concern on the part of the caregiver and the pediatrician. This book was conceptualized by a child neurologist (LS) and an academic pediatrician (DK) with clinical experiences in a wide variety of settings. We bring the unique perspectives of both fields to this book. When a newborn or a child has a symptom that might have a neurological basis, it may be most reassuring to consult with a colleague in neurology. However, that may not be practical in all settings. Further, parents may do their own “research” and obtain information from non- medical sources that they bring to the discussion. While imaging has indeed revolu- tionized neurology as we know it, the primary care physician must still obtain a relevant history and conduct a pertinent physical examination to provide the best care. This book has been formulated keeping the primary care physician’s workflow in mind. Dispensing with the traditional “where is the lesion” and “what is the lesion” model of neurology, where one presumes a thorough knowledge of neuro- anatomy and clinical correlates, we chose to proceed with the more practical “what is the story” and “what do I see on my examination” to arrive at a diagnosis. We invited experts in the field to contribute to each chapter and asked that they place themselves in the shoes of the primary care doctor. We tried to avoid jargon, cumbersome neuropathological correlates, and in-depth reviews of disease pro- cesses—making the assumption that after making a presumptive diagnosis, the physician may choose to refer the patient to a specialist and/or continue to provide care alongside a specialist. We have placed an introductory chapter on how to conduct a neurological examination in children of different age groups that we hope the primary care physician will review this before reading individual chapters. We also outlined common neurological investigations and their interpretation—as results of imaging and EEG are often reviewed by parents on the electronic portal—even v vi Preface before the physician may have looked over them, leading to anxious calls! There are numerous tables that one can consult quickly. The differential diagnosis section is comprehensively laid out as the relevant question at the end of any clinical encounter (especially with a neurological symptom) is “did I miss an important condition?” Conditions such as concussion, a child with febrile seizures or first-time seizures, cerebral palsy, and functional neurological disorders will be encountered by every primary care doctor. On the other hand, neurocutaneous syndromes and autoimmune encephalitis may not. Nonetheless, a working knowledge of such conditions will allow primary care doctors to triage, refer, and start the investigative process with confidence. Considering that most children with neurological conditions will be evaluated and managed by primary care physicians, we believe that this book may be helpful in providing comprehensive care to such families. San Antonio, USA Deepak M. Kamat Detroit, USA Lalitha Sivaswamy Contents Neurological Examination of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Lalitha Sivaswamy Child with Altered Mental Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Katherine Cashen, Amarillis Martin, and Ahmed Aly Child with Global Developmental Delay . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Leigh Anne Flore and Stephanie Campbell Child with Suspected Autism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Aram Kim and Deepa S. Rajan Child with Attention Deficit Disorder/Child with Attention Deficit Hyperactivity Disorder (ADHD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Kimberley Levitt and Barbara Felt Child with Alterations of Mood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Richard Dopp, Priyanka Reddy, and Gregory Hanna Child with New Onset Convulsive Seizure . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Amanda Weber and Aimee F. Luat Neonate/Infant with Seizures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Arnold J. Sansevere and Chellamani Harini Child with Febrile Seizures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Rajkumar Agarwal and Roshani Agarwal Child with Epilepsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Norimitsu Kuwabara and James W. Wheless Status Epilepticus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Cristina Rosado Coelho and Jun T. Park Child with Syncope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Diana M. Torpoco Rivera, Marjorie Gayanilo, and Sehgal Swati vii viii Contents Child with Sleep Disturbances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 Sanjeev V. Kothare and Ivan Pavkovic Child with Unilateral or Bilateral Vision Loss . . . . . . . . . . . . . . . . . . . . . . . 245 Amanda A. Ismail and Robert L. Tomsak Child with Diplopia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265 Homer Chiang, Martha P. Schatz, and Ujwala S. Saboo Child with Facial Weakness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293 Danielle Nolan and Daniel Arndt Hearing Loss in Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303 Sonal Saraiya and Catherine Mae Geller Worst Headache of Their Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329 M. Cristina C. Victorio and Kelsey Merison Child with Chronic Headache . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347 Naznin Mahmood and Lalitha Sivaswamy Child with New Onset Headache . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365 Riddhiben Patel Child with New Onset Paraparesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385 Erin E. Neil Knierbein Child with New Onset Hemiparesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401 Melissa G. Chung Child with Tics and Other Common Movement Disorders . . . . . . . . . . . . 423 Keisuke Ueda and Kevin J. Black Child with Congenital and Acquired Torticollis. . . . . . . . . . . . . . . . . . . . . . 445 Barbara Sargent and Young Ah Lee Child with Microcephaly or Macrocephaly . . . . . . . . . . . . . . . . . . . . . . . . . 463 Ishani Kumar and Nancy McNamara Child with Ataxia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487 Swati A. Karmarkar and Deepa S. Rajan Child with Gait Disturbances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501 Meghan Harper-Shankie and Heather Little Child with Dizziness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 513 Ross J. O’Shea and Jacob R. Brodsky Cerebral Palsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 541 Jenny L. Wilson, Bhooma R. Aravamuthan, and Jennifer A. O’Malley Child with Closed Head Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 565 Andrea Almeida, Bara Alsalaheen, Matt Lorincz, and Andrew Hashikawa Contents ix Child with Neurocutaneous Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 583 James H. Tonsgard and Nikolas Mata-Machado Child with Suspected Autoimmune Encephalitis . . . . . . . . . . . . . . . . . . . . . 625 Jenny Joseph and J. Nicholas Brenton Child with Suspected Metabolic Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . 639 Kara Pappas, Noelle Andrea V. Fabie, and Gerald L. Feldman Myasthenia Gravis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 653 Kelsey Christoffel and Duygu Selcen Approach to an Infant with Hypotonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 667 Gyula Acsadi and William D. Graf Child with Acute Limb Weakness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 683 John Brandsema and Ryan Cappa Functional Neurological Disorder in Children and Adolescents . . . . . . . . 699 Kasia Kozlowska and Shekeeb Mohammad Neurodiagnostic Studies in Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 725 Kallol K. Set and Deepak M. Kamat Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 755 Neurological Examination of Children Lalitha Sivaswamy 1 Introduction The neurological examination is often considered challenging [1]. Since the nervous system is the most complex of all systems, a comprehensive neurological examination involves many components which may be difficult to perform in an anxious/uncooperative child [2]. Further, the examination should be tailored to the age and developmental stage of the child. While the history can help the clinician focus on certain portions of the neurological examination, it is important to conduct a complete neurological examination on every child who presents with a symptom referable to the nervous system. The nervous system is traditionally divided into the examination of the upper motor neuron pathway, i.e., brain and spinal cord and the lower motor neuron pathway, i.e., the anterior horn cells, plexus, peripheral nerve, neuromuscular junction, and muscle. This chapter will review salient aspects of the neurological examination in infants, young children, and adolescents. The older the child, the more the examination will resemble that of an adult and technically should be easier to perform. Nonetheless, adopting a streamlined approach will avoid overlooking important physical clues that can guide decision-making and further investigations or referrals. In addition, one must also perform a thorough general physical examination including assessment of vital signs with emphasis on examination of the skin, facial appearance, and limbs as well as measuring the head circumference. Important clues on the general examination that can guide the clinician toward a neurological diagnosis are noted in Table 1. L. Sivaswamy (*) Pediatrics and Neurology, Central Michigan University, Children’s Hospital of Michigan, Detroit, MI, USA e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature 1 Switzerland AG 2022 D. M. Kamat, L. Sivaswamy (eds.), Symptom-Based Approach to Pediatric Neurology, https://doi.org/10.1007/978-3-031-10494-7_1