Curbside Consultation in Pediatric Neurology: 49 Clinical Questions

• When should I consider head imaging in a child with headache?  CT or MRI?
• What is the acute management after a concussion?  When can a child return to school and sports?
• What are the important things to consider when you see a child with the complaint of vision changes?
• Are there any diet changes or vitamins that may help a child with epilepsy?
• What are the signs of a stroke in a child? Are there other conditions that can present like a stroke?
• What are common causes of acute ataxia?
• What are the neurodevelopmental disorders leading to language delay and what work-up is needed?
• What are the Causes of Guillain-Barré Syndrome, How Often Does It Occur, and How Do You Treat It?

Dedication
About the Editors 
Contributing Authors 
Introduction  

SECTION I SEIZURES 
Question 1 How Are Seizures Classified? 
Nicole R. Ryan, MD
Question 2 How Do I Distinguish Syncope From Seizure? 
Daphne M. Hasbani, MD, PhD
Question 3 Are Children With Febrile Seizures at Greater Risk for Epilepsy? Which of These Patients Should Be Referred to a Neurologist? 
Ryan P. Williams, MD, EdM
Question 4 Are the Benign Childhood Epilepsies Really Benign? 
Katherine S. Taub, MD
Question 5 Do Seizures Cause Developmental Delay? Can Treating the Seizures Help? 
John R. Mytinger, MD
Question 6 Does Epilepsy Run in Families? 
Jason Coryell, MD, MS
Question 7 Are There Any Diet Changes or Vitamins That May Help a Child With Epilepsy? 
Adam L. Hartman, MD and Brian Masselink, MD
Question 8 Do Children “Outgrow” Epilepsy? 
Emily A. Gertsch, MD, MPH and Kelly Knupp, MD
Question 9 What Are Common Side Effects of Antiseizure Medications?
Laufey Yr Sigurdardottir, MD
Question 10 When Is Epilepsy Considered “Refractory”? What Happens Next? 
Karen L. Skjei, MD
Question 11 Can a Child With Seizures Receive All Vaccinations? 
Kashif Ali Mir, MD and Karen L. Skjei, MD
Question 12 What Do I Do When a Child Seizes in My Office? Can a Child Die From Seizures? 
Mai T. Dang, MD, PhD and Ernest Barbosa, MD

SECTION II ALTERED MENTAL STATUS: METABOLIC, INFECTIOUS, TOXINS/DRUGS/CONCUSSION 
Question 13 What Is a Breath-Holding Spell? Can It Be Treated? 
Donna J. Stephenson, MD
Question 14 A Mother Calls Because Her Child Has Had Episodes of Confusion Over the Last Week but Is Otherwise Acting Normally. How Should the Child Be Evaluated?
Caitlin Rollins, MD
Question 15 A Child Has Had a Progressive Decline in School Performance Over the Last Few Months. How Should This Be Evaluated? 
Xilma R. Ortiz-Gonzalez, MD, PhD

SECTION III HEADACHE 
Question 16 What Are the Most Common Types of Headaches in Children? 
Christina Szperka, MD and Douglas Smith, MD
Question 17 When Should I Consider Head Imaging in a Child With Headache? Computed Tomography or Magnetic Resonance Imaging?
Laura A. Adang, MD, PhD
Question 18 What Medications Are Best to Abort a Migraine? 
Steven Kugler, MD
Question 19 Are There Ways to Prevent Migraines? What Lifestyle Factors Contribute to Headaches? 
Christina Szperka, MD and Emily Robbins, MD
Question 20 Are Tension-Type Headaches Treated Differently From Migraines? 
Joyce Sapin, MD
Question 21 What Is a “Migraine Variant”? Is It Treated Differently? 
Daniel J. Licht, MD
Question 22 What Can Be Done for a Post-Concussive Headache? 
Nicole R. Ryan, MD

SECTION IV FLOPPY BABY 
Question 23 What Are the Most Important Components of the Exam in Evaluating a Hypotonic Baby? 
Sabrina W. Yum, MD
Question 24 How Do I Distinguish Central From Peripheral Causes of Hypotonia? 
Michele L. Yang, MD
Question 25 What Are the Most Common Genetic Causes of Hypotonia? 
Michele L. Yang, MD
Question 26 What Are the Clinical Features of Infant Botulism? How Is It Treated? 
Jennifer L. McGuire, MD, MSCE

SECTION V CONCUSSION 
Question 27 How Do I Know if a Child Has Had a Concussion? 
Christina L. Master, MD, FAAP, CAQSM
Question 28 What Is the Role for Head Imaging in Suspected Concussion? 
Matthew P. Kirschen, MD, PhD and Ronald F. Marchese, MD
Question 29 What Is the Acute Management After a Concussion? When Can a Child Return to School and Sports? 
Matthew Grady, MD, FAAP, CAQSM and Christian Turner, MD, FAAP, CAQSM
Question 30 What Is Post-Concussive Syndrome? 
Matthew P. Kirschen, MD, PhD and Maximillian H. Shmidheiser, PsyD, ABPP-CN

SECTION VI WEAKNESS 
Question 31 How Do You Evaluate Acute Weakness in a Child? 
Diana X. Bharucha-Goebel, MD
Question 32 What Are the Causes of Guillain-Barré Syndrome, How Often Does It Occur, and How Do You Treat It? 
Jennifer L. McGuire, MD, MSCE

SECTION VII FOCAL NEUROLOGICAL DISEASE 
Question 33 What Are the Signs of a Stroke in a Child? Are There Other Conditions That Can Present Like a Stroke? 
Renée A. Shellhaas, MD, MS and Louis T. Dang, MD, PhD
Question 34 What Can I Tell a Parent to Expect About the Recovery From a Perinatal-Onset Arterial Ischemic Stroke? How About a Childhood-Onset Arterial Ischemic Stroke?
Lauren A. Beslow, MD, MSCE and Lori L. Billinghurst, MD, MSc, FRCPC
Question 35 What Is the Chance of Developing Epilepsy After Stroke? 
Courtney J. Wusthoff, MD, MS
Question 36 What Causes a Child to Have a Stroke? 
John M. Binder, MD; Amanda L. Hollatz, MA; and Timothy J. Bernard, MD, MSCS

SECTION VIII VISION PROBLEMS 
Question 37 What Are the Important Things to Consider When You See a Child With the Complaint of Vision Changes? 
Robert A. Avery, DO, MSCE
Question 38 What Is the Evaluation of a Child With Optic Nerve Head Elevation (Papilledema)? 
J. Michael Taylor, MD and Robert A. Avery, DO, MSCE

SECTION IX VERTIGO 
Question 39 What Is the Difference Between Vertigo and Dizziness? What Are Common Causes of Both? 
Alyssa Pensirikul, MD
Question 40 How Should Vertigo Be Evaluated and Treated? 
Alyssa R. Rosen, MD

SECTION X ATAXIA 
Question 41 What Are Common Causes of Acute Ataxia in Children? 
David Bearden, MD
Question 42 How Do You Distinguish Weakness From Ataxia? 
Amy T. Waldman, MD, MSCE
Question 43 How Do You Tell a Pathologic Gait From a Functional Gait? 
Laura A. Adang, MD, PhD

SECTION XI GENETIC DEVELOPMENTAL DELAY 
Question 44 How Should I Begin a Workup for a Child With Significant Developmental Delay? 
Ethan M. Goldberg, MD, PhD
Question 45 What Is a Good Approach to Thinking About a Child With Multiple Dysmorphisms? 
Mai T. Dang, MD, PhD
Question 46 When Should I Think About a Mitochondrial Disorder, and What Is a Good Approach to an Initial Evaluation? 
Xilma R. Ortiz-Gonzalez, MD, PhD
Question 47 What Are the Neurodevelopmental Disorders Leading to Language Delay and What Workup Is Needed? 
Laufey Yr Sigurdardottir, MD

SECTION XII UNUSUAL EPISODIC MOMENTS 
Question 48 How Are Movement Disorders Classified and Why Is That Important? 
Jessica A. Panzer, MD, PhD
Question 49 How Do I Diagnose Tics and How Do I Treat Them? When Is It Considered Tourette Syndrome? 2
Donna J. Stephenson, MD

Financial Disclosures 
Index