Chapter 20: Care of children and young people with neurological problems

ANSWERS TO SCENARIO 20.1: SIMON

Simon, aged 9 years, had a three-week history of vomiting and headaches. He had visited the GP four times and was diagnosed with childhood migraines and given pain killers.  Mum and Dad were unhappy with his diagnosis and took Simon to his local Emergency department.  He was seen by the on-call paediatrician and sent for a head CT scan.  This showed a large posterior fossa lesion (brain tumour) and dilated ventricles (hydrocephalus) with signs of RICP.  Simon was transferred to a paediatric neurosurgical unit. 

  • How would you describe Simon’s raised ICP using the Monro-Kellie Doctrine?

Answer: Simon’s brain tumour has most likely caused a blockage of the CSF pathways in the region of the fourth ventricle and subsequent enlargement of the cerebral ventricles and raised ICP.  In this situation the first compensatory mechanism most likely to occur would be the collapse of the cerebral veins and sinuses displacement of venous blood.  The CSF spaces are unable to reduce in size due to the existing hydrocephalus.

  • Does Simon have a non-communicating (obstructive) or a communicating type of hydrocephalus?

Answer: Simon will probably have a non-communicating (obstructive) type of hydrocephalus caused by a blockage of the CSF pathways in the region of the fourth ventricle.

ANSWERS TO SCENARIO 20.2: SARAH

Sarah is 15 years old and has a history of runny nose and headache.  Her mother reported that she has had a fever for the past three days. While waiting in A&E she had a generalised tonic clonic seizure. 

  • What action would you initially take?

Answer:

1. Safety; Stimulate; Shout (BLS)

2. Assess and intervene ABCD

Possible interventions:

Get help

Airway: Chin lift, gentle suction

Breathing: Give oxygen via a non-re-breathing mask with reservoir (15 litres/min)

Circulation: Establish IV/IO access if none

(give initial seizure care)

3. Reassess ABCD

  • How would you manage Sarah’s seizure?

Answer: Give anti-convulsant drugs:

Step 1(APLS, 2016).

IV lorazepam 100 micrograms/kg if IV access available, if not, rectal diazepam (0.5mg/kg) or buccal midazolam (0.5mg/kg) should be administered as an alternative.

Reference

Advanced Paediatric Life Support Group (APLSG) (2016) The Practical Approach, 6th edn. Chichester: Wiley-Blackwell.