Aim To examine the characteristics of primary stabbing headache (PSH) in typically developing children and adolescents. Method In this prospective non‐interventional hospital‐based study, we examined 42 eligible individuals (24 females, 18 males; 26 white; mean age 12y 1mo, range 6y–16y 1mo) with spontaneous transient stabs. A headache focused history and/or a headache diary was obtained from each patient. All patients had normal neurological examination. Diagnosis of primary headache was based on the International Classification of Headache Disorders, Third Edition (ICHD‐3) beta version. Results Duration of stabs ranged from a few seconds to up to 10 minutes. Stabs were located in a variety of sites on the cranium but mostly in the extra‐trigeminal regions (n=28). Intensity of stabs varied from moderate (n=4) to severe (n=38). The frequency of the stabs ranged from daily to monthly. There were up to 50 stabs per headache attack. Stabs among our patients occurred independently from those caused by other primary headache types. Accompanying symptoms during stabs were reported by eight patients. Family history of primary headaches was identified (n=17). Familial transmission of PSH was recognized among two patients. All patients had normal brain magnetic resonance imaging. Interpretation The presentation and nature of PSH in children and adolescents varies widely. PSH in children may be a different entity to that in adults, and there is a need for further research to support changes in the ICHD‐3 criteria for PSH in children and adolescents. What this paper adds Presentation of childhood primary stabbing headache (PSH) varies widely. Duration of PSH could last from a few seconds up to 10 minutes.

We report a case of a 10-day-old male infant who presented to the emergency department with severe electrolyte imbalance and life-threatening arrhythmia. The parents reported a 3-day history of poor feeding and lethargy. On examination, he was bradycardic (heart rate of 65 beats/min) with signs of dehydration. His ECG showed broad complex bradycardia. Blood gas showed metabolic acidosis with hyponatraemia and hyperkalaemia. A probable diagnosis of congenital adrenal hyperplasia (CAH) with salt-wasting crisis was made and treatment was commenced. He was given saline bolus, nebulised salbutamol, calcium gluconate and hydrocortisone. Following the above interventions, his heart rate rose to 150 beats/min with a regular sinus rhythm within a period of 40 min. The diagnosis of CAH secondary to 21-hydroxylase deficiency with mutation in CYP21A2 was confirmed by genetic studies. He was discharged home with hydrocortisone, fludrocortisone and sodium chloride.

Management of CNS infections requires specific antimicrobial agents, as well as specific supportive treatment targeted at reducing raised intracranial pressure and other life-threatening complications. It is important that the need for management in an intensive care setting is considered early in the illness. Antibiotic resistance amongst the most common organisms causing bacterial meningitis is becoming more common and antibiotic therapy should be adjusted accordingly. Anti-inflammatory treatment such as steroids should be started as soon as possible in patients with proven acute bacterial meningitis. Optimally, this should be before or with the first dose of antibiotics. Vaccine research is progressing so that effective vaccines should be available in the future against all the common causes of bacterial meningitis and encephalitis, including Neisseria meningitidis serogroup b.

Despite advances in antimicrobial therapy, central nervous system infections have a high morbidity and mortality. Most pathogens reach the brain by haematogenous spread following invasion through the mucosal surface of the nasopharynx. The cerebrospinal fluid inflammatory response is responsible for most of the deleterious effects of the infection. Understanding this response has allowed a more rational approach to therapy. Patients may present with non-specific features, especially neonates, infants, post-neurosurgical patients, and the elderly. This chapter will review the epidemiology, pathophysiology, clinical presentation, and diagnosis of acute bacterial meningitis and encephalitis.

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