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Know your stroke mimics
A developmentally normal and previously well 15-year-old boy, presented to hospital with a 4-hour history of gradually worsening, throbbing, left-sided headache spreading across his whole head. Four hours prior, he could not read properly or string words together and felt tired. He developed a headache followed by expressive aphasia, agitation and vomiting. A right-sided lower facial droop was noted that resolved in a couple of hours. He played a rugby match in the morning and there was a history of minor head injury without loss of consciousness. He started to develop self-resolving apnoeic episodes each lasting for 30&nd...
Source: Archives of Disease in Childhood - Education and Practice - March 17, 2023 Category: Pediatrics Authors: Hanna, D., Holland, J., Lichtblau, N., Maduakor, C., Khan, F., Kerr, T. Tags: Epilogue Source Type: research

Unusual case of stroke in childhood
You receive a prealert call from a paramedic team stating they are managing a 12-year-old girl with acute left-sided weakness. As you prepare for the patient’s arrival, you go through a list of potential differentials. Question 1 Which of the following is not part of the differential list? Haemorrhagic stroke. Hypoglycaemia. Bell’s palsy. Migraine. Todds’ paresis. Question 2 What is the recommended time to CT following this type of presentation to the emergency department? 15 min. 40 min. 60 min. 120 min. The time to CT is only applicable to adult patients. The family report intermittent frontal headaches...
Source: Archives of Disease in Childhood - Education and Practice - September 19, 2022 Category: Pediatrics Authors: Mawhinney, D. C., Mullen, S., Clarke, N. Tags: Epilogue Source Type: research

Different stroke(s)
A 13-year-old boy with mild learning difficulties presented to his district general hospital after an unwitnessed episode of collapse with vomiting but no loss of consciousness. He had 3 days of lethargy and intermittent occipital headaches waking him from sleep. Two days later, after another ‘funny turn’, he represented with right-side paraesthesia, weakness and word-finding difficulty. He had three previous ‘collapses’ over the last 6 months, including symptoms of transient dizziness, slurred speech, dribbling, difficulty swallowing and left-facial paraesthesia from which he had recovere...
Source: Archives of Disease in Childhood - Education and Practice - May 17, 2016 Category: Pediatrics Authors: Mundada, V., Krishnakumar, D., Chitre, M., Das, T. Tags: Oncology, Eye Diseases, Drugs: cardiovascular system, Echocardiography, Headache (including migraine), Infection (neurology), Neurooncology, Pain (neurology), Stroke, Hypertension, Ophthalmology, Valvar diseases, Radiology, Rheumatology, Dermatology, Clin Source Type: research

Answers to Illuminations questions
Answers (1) False, (2) False, (3) True, (4) False, (5) True, (6) False, (7) True, (8) True. This patient has an acute, non-haemorrhagic right middle cerebral territory infarct. There was involvement of the right precentral and postcentral gyri (motor and sensory areas) on other images. The axial T2-weighted image (figure 1) demonstrates high signal in swollen/oedematous ischaemic cortex with effacement of the sulci. There is also restricted diffusion in the affected area, with corresponding high/increased signal (bright) on DWI (figure 2), and low signal (dark) on the apparent diffusion coefficient (ADC) map (figure 3). In...
Source: Archives of Disease in Childhood - Education and Practice - May 17, 2016 Category: Pediatrics Authors: Williams, H. Tags: Oncology, Journalology, Echocardiography, Epilepsy and seizures, Headache (including migraine), Infection (neurology), Neurooncology, Stroke, Child health, Radiology, Clinical diagnostic tests, Radiology (diagnostics), Competing interests (ethics) Illum Source Type: research

Fifteen minute consultation: headache in children under 5 years of age
Headache occurring in children under the age of 5 years may cause a high level of anxiety in both parents and medical professionals. Crucial to a consultation about this problem will be to actively seek out clues to sinister pathologies, and investigate or reassure as appropriate. Making a positive diagnosis of a primary headache disorder where one exists is also important; however, in young children, headache does not always conform to well-established diagnostic criteria. This short guide provides a practical overview using the scenario of a new referral to the outpatient clinic.
Source: Archives of Disease in Childhood - Education and Practice - September 5, 2013 Category: Pediatrics Authors: McCrea, N., Howells, R. Tags: Headache (including migraine), Pain (neurology), Stroke, Child health Best practice Source Type: research

How to use... lupus anticoagulants
Introduction Lupus anticoagulants (LA) were first detected in patients with systemic lupus erythematosus (SLE) in 1952 by Conley and Hartmann.1 They identified patients in whom the activated partial thromboplastin time (APTT) was prolonged and which did not correct on the addition of normal plasma. Although Conley and Hartmann's original description was in association with a haemorrhagic disorder, subsequent reports from the 1960s highlighted patients with thrombotic events in the presence of LA.2 The term ‘lupus anticoagulant’ was introduced by Feinstein and Rapaport in 1972.3 It has, however, caused some conf...
Source: Archives of Disease in Childhood - Education and Practice - March 14, 2013 Category: Pediatrics Authors: Sen, E. S., Beresford, M. W., Avcin, T., Ramanan, A. V. Tags: Liver disease, Immunology (including allergy), Hepatitis and other GI infections, Travel medicine, Epilepsy and seizures, Headache (including migraine), Stroke, Pregnancy, Reproductive medicine, Rheumatology Interpretations Source Type: research

Chronic abdominal pain in children: help in spotting the organic diagnosis
Case 1 Aisha, a 9-year-old Asian girl, was referred to the paediatric outpatient clinic by her general practitioner (GP) with a 4 month history of episodic central abdominal pain. Each episode would last a few hours, affecting her about three times per week, usually during the day, but also occasionally at night. This was associated with infrequent, non-bilious vomits but did not appear to be related to diet. She was missing some days of school because of her symptoms. She said she liked school, did not like missing days away from her friends and denied any bullying. Between episodes she was a well and active girl. Sh...
Source: Archives of Disease in Childhood - Education and Practice - January 16, 2013 Category: Pediatrics Authors: Wright, N. J., Hammond, P. J., Curry, J. I. Tags: GI bleeding, Constipation, Diarrhoea, Editor's choice, Headache (including migraine), Pain (neurology), Stroke, Childhood nutrition, Diet, Child and adolescent psychiatry (paedatrics), Childhood nutrition (paediatrics), Child health, Neonatal health, Radi Source Type: research