Cyclic Vomiting Syndrome in Children

Donnet, Anne; Redon, Sylvain

doi:10.1007/s11916-018-0684-6

Cited by 19 publications

(16 citation statements)

References 146 publications

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“…CVS is an idiopathic chronic periodic disorder of childhood, with a prevalence of about 0.4–1.9 per 100 [ 8 ]. The diagnosis is clinical and is commonly based on ICHD-III, The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition consensus statement [ 9 ], and/or the ROME IV criteria [ 10 ]. The hallmark consists of stereotypical episodes of vomiting, occurring at least 1 week apart, and in the absence of positive findings on laboratory, radiographic, or endoscopic testing [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Atypical idiopathic intracranial hypertension presenting as cyclic vomiting syndrome: a case report

et al. 2021

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Background Idiopathic intracranial hypertension is a disorder of increased intracranial pressure in the absence of cerebrospinal outflow obstruction, mass lesion, or other underlying cause. It is a rare phenomenon in prepubertal children and is most typically found in women of childbearing age. The classic presentation consists of headaches, nausea, vomiting, and visual changes; however, children present more atypically. We report a case of idiopathic intracranial hypertension in an otherwise healthy, 4-year-old child with atypical symptoms resembling those of cyclic vomiting syndrome. Case presentation A 4-year-old Caucasian, otherwise healthy, male child presented to our emergency department with episodic intermittent early-morning vomiting occurring once every 1–3 weeks without interepisodic symptoms, starting 10 months prior. With outpatient metabolic, autoimmune, endocrine, allergy, and gastroenterology work-up all unremarkable, he was initially diagnosed with cyclic vomiting syndrome. Discovery of mild optic nerve sheath distension on magnetic resonance imaging of the brain 10 months after symptom onset led to inpatient admission and a lumbar puncture notable for an opening pressure of 47 mmHg, with normal cell count and protein levels. He had no changes in visual acuity or optic disc edema on dilated fundoscopic examination. The patient was started on acetazolamide, with resolution of episodic emesis at his last follow-up visit 12 weeks after discharge. Conclusions Idiopathic intracranial hypertension presents atypically in prepubescent children, with about one-fourth presenting asymptomatically, and only 13–52% presenting with “classic” symptoms. With a prevalence of only 0.6–0.7 per 100,000, much remains unknown regarding the underlying pathophysiology in this demographic. Cyclic vomiting syndrome, however, has a much higher prevalence in this age group, with a prevalence of 0.4–1.9 per 100. It is thought to be an idiopathic, periodic disorder of childhood, often linked to neurological conditions such as abdominal migraines, epilepsy, mitochondrial disorders, and structural lesions such as chiari malformation and posterior fossa tumors. While cyclic vomiting syndrome is thought to have a benign course, untreated idiopathic intracranial hypertension can have long-term detrimental effects, such as visual loss or even blindness. We present a case of idiopathic intracranial hypertension presenting with symptoms resembling cyclic vomiting syndrome in a 4-year-old child, diagnosed 10 months after initial onset of symptoms. We aim to demonstrate the need for a high level of clinical suspicion and the need for further investigation into underlying pathophysiology in this vulnerable population.

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Section: Discussionmentioning

confidence: 99%

Atypical idiopathic intracranial hypertension presenting as cyclic vomiting syndrome: a case report

et al. 2021

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“…CVS was originally thought to be predominantly a pediatric illness [82] and, in children, CVS may be associated with autonomic dysfunction. Abnormal levels of adrenocorticotropic and antidiuretic hormones have been hypothesized [83, 84]. However, pediatric CVS may also be idiopathic.…”

Section: Resultsmentioning

confidence: 99%

Cannabinoid Hyperemesis

Pergolizzi Jr.,

LeQuang,

Bisney

2018

Med Cannabis Cannabinoids

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Cannabinoid hyperemesis syndrome (CHS) is a paradoxical condition in which a long-term cannabis user suffers an episode of intractable vomiting that may last days separated by longer asymptomatic periods of weeks or months. Cannabinoids are often utilized for their antiemetic properties, so CHS can be a puzzling condition, and the diagnosis of CHS may be disputed by patients. Unlike other cyclic vomiting syndromes, CHS can be relieved by hot showers or topical capsaicin. Abstinence from cannabinoids causes CHS to resolve, sometimes in a matter of days or hours. Marijuana users as well as many clinicians are not aware of CHS, and patients may undergo unnecessary tests, scans, and other procedures to get an accurate diagnosis. Symptoms may be severe enough to require hospitalization. With liberalization of marijuana laws and favorable public opinion about the healing properties of cannabis, CHS may be more frequently observed in clinical practice.

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“…15 Lack of reported findings with Hispanic and non-Hispanic black youth in the current study is associated with a lack of diversity in rural WV as evidenced by a racial/ethnic mix of 92% White, 4% Black, 0% Native American, 1% Asian, and 0% other with 1% Hispanic. 18 OSAS occurs more frequently among children with obesity and is also a comorbidity with migraine. The prevalence of OSA has been reported at 44.6 to 56% in the obese pediatric population 19,20 and 40 to 56.6% in children with migraine.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Obesity, Migraine, and Overlapping Comorbidities in a Rural Pediatric Population

Walter

Dai

Wang

2021

JNRP

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Objective This study aims to report the prevalence of obesity and overlapping comorbidities in a rural population of children and adolescents with migraine. Design and Methods A cross-sectional, descriptive, secondary data analysis using a comprehensive patient database from the West Virginia University (WVU) Medicine Epic Clarity system will be reported. A review of electronic medical records of 990 children and adolescents, ages 7 to 17 years, evaluated for headache at a rural clinic from December 1, 2009 to December 31, 2017 was completed. The Chi-square test was used to identify any differences in demographic characteristics (age, gender, and race) and distribution of comorbidities (obstructive sleep apnea syndrome [OSAS], depression, and anxiety) among obese versus nonobese adolescents with migraine. Student’s t-test was used to identify any differences in the number of comorbidities between the two groups. Results A total of 648 children and adolescents with a diagnosis of migraine were identified. Approximately 26.4% of the children and adolescents diagnosed with migraine (n = 648) met the criteria for being obese with a mean body mass index (BMI) of 30.6 kg/m2 (standard deviation [SD] = 6.5), ranging from 20.0 to 58.5 kg/m2. There were no significant differences between migraineurs who were categorized as obese versus nonobese in terms of gender (p = 0.8587), age (p = 0.1703), race (p = 0.7655), anxiety (p = 0.1841), or depression (p = 0.2793). Obese individuals have more comorbidities than nonobese individuals (p = 0.015). Additionally, the prevalence of OSAS was significantly higher among obese versus nonobese migraineurs (20 vs. 9.9%, p = 0.0007). Conclusion Given the prevalence of obesity in rural pediatric populations and the reported neurobiological links between migraine and obesity, BMI needs to be monitored and weight management interventions included in plans of care for rural children and adolescents with migraine.

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Cyclic Vomiting Syndrome in Children

Cited by 19 publications

References 146 publications

Atypical idiopathic intracranial hypertension presenting as cyclic vomiting syndrome: a case report

Atypical idiopathic intracranial hypertension presenting as cyclic vomiting syndrome: a case report

Cannabinoid Hyperemesis

Obesity, Migraine, and Overlapping Comorbidities in a Rural Pediatric Population

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