Gregory L. MD Holmes - Pediatric Neurology

SERIES CO-EDITORS-IN-CHIEF

Lawrence C. Newman, MD

Director of the Headache Institute

Department of Neurology

St. Lukes-Roosevelt Hospital Center

New York, New York

Morris Levin, MD

University of California

San Francisco

OTHER VOLUMES IN THE SERIES

Headache and Facial Pain

Peripheral Nerve and Muscle Disease

Pediatric Neurology

Stroke

Epilepsy

Neuro-ophthalmology

Neuroimmunology

Pain

Neuroinfections

Emergency Neurology

Cerebrovascular Disease

Movement Disorders

Neurogenetics

Neurotology

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Published in the United States of America by Oxford University Press

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Oxford University Press 2016

First Edition published in 2010

Second Edition published in 2016

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Library of Congress Cataloging-in-Publication Data

Names: Holmes, Gregory L., author. | Bingham, Peter M., author.

Title: Pediatric neurology / Gregory L. Holmes, Peter M. Bingham.

Other titles: What do I do now?

Description: Second edition. | Oxford ; New York : Oxford University Press, 2016. |

Series: What do I do now? | Includes bibliographical references and index.

Identifiers: LCCN 2015044626 | ISBN 9780190601508 (paperback : alk. paper) |

ISBN 9780190601522 (e-book) | ISBN 9780190601515 (e-book) | ISBN 9780190601539 (online)

Subjects: | MESH: ChildCase Reports. | Nervous System DiseasesCase Reports. | AdolescentCase Reports. | InfantCase Reports.

Classification: LCC RJ486 | NLM WS 340 | DDC 618.92/8dc23

LC record available at http://lccn.loc.gov/2015044626

This material is not intended to be, and should not be considered, a substitute for medical or other professional advice. Treatment for the conditions described in this material is highly dependent on the individual circumstances. And, while this material is designed to offer accurate information with respect to the subject matter covered and to be current as of the time it was written, research and knowledge about medical and health issues is constantly evolving and dose schedules for medications are being revised continually, with new side effects recognized and accounted for regularly. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulation. The publisher and the authors make no representations or warranties to readers, express or implied, as to the accuracy or completeness of this material. Without limiting the foregoing, the publisher and the authors make no representations or warranties as to the accuracy or efficacy of the drug dosages mentioned in the material. The authors and the publisher do not accept, and expressly disclaim, any responsibility for any liability, loss or risk that may be claimed or incurred as a consequence of the use and/or application of any of the contents of this material.

We are grateful to Mo Levin and Larry Newman for instigating the earlier edition of the What Do I Do Now?Pediatric Neurology series. Craig Panner and Rebecca Suzan from Oxford University Press were very supportive in the planning and completion of this work. Most of all, we thank our patients and our colleagues at the University of Vermont Childrens Hospital, who continue to teach us much about pediatric neurology.

Gregory L. Holmes

Peter M. Bingham

Burlington, Vermont

Pediatric neurology is a challenging yet fascinating discipline that studies neurological diseases in a growing and maturing nervous system. The variety of clinical presentations, responses to therapy, and outcomes all reflect the highly plastic, impressionable nature of the developing human nervous system. Considering the evolving nature of clinical work and practice standards in this field, it is timely and appropriate for the editors to provide an updated edition of What Do I Do Now? Pediatric Neurology.

The 31 cases that make up this book come from our experience as pediatric neurologists over the past 30 years. Pediatric neurology has developed into a broad specialty, incorporating disciplines ranging from neuromuscular disease to neurogenetics to neurometabolic disorders. The cases presented here represent a mere snapshot of some common and some less common disorders encountered by pediatric neurologists. This book is by no means a comprehensive review of any of the topics; rather, we compare this book to wine tasting, where one can sample wine in small aliquots; the interested reader gets a brief taste of a variety of pediatric cases. The scenarios are designed to entice the reader to consider what he or she would do next. While we have included lists of differential diagnoses for many of the cases, most astute clinicians can reduce the differential diagnosis to a few possibilities after taking a history and performing an examination. We have therefore purposely tried to eliminate rare and unlikely conditions from the differential diagnoses.

This book is targeted toward pediatricians, family practitioners, adult neurologists, medical students, and nurse practitioners. Most of the cases presented here could be managed by interested healthcare professionals without formal pediatric neurology training, as in many parts of the country pediatric neurologists arent readily available for consultation. Each case is short, encompassing salient features of the diagnosis. The cases are not meant to be tricky or misleading.

We hope this book will convey our own excitement as we work on a daily basis with children with neurological disorders. Ideally this book will motivate readers to dig deeper into the literature to learn more about the disorders. If this book is successful in helping even a single child with a neurological disorder, the effort will have been worthwhile.

Gregory L. Holmes, MD

Peter M. Bingham, MD

Burlington, Vermont

You are called by a pediatrician who is seeing a 7-year-old girl with staring episodes. According to the pediatrician, teachers have noted the child stares off into space frequently. During the episodes the girl does not respond to questions. The pediatrician suspects the child is daydreaming but calls you to see if he should obtain an EEG.