It is a series of blog-post, for asynchronous learning written by Dr Vasu Burli which are actually his handpicked notes he derived from Nelson Textbook of Pediatrics. The notes are divided system-wise. The second in this series is ready to go online!
Series 1: CNS Questions
1. Breath holding spells
2. Brain abscess
| About Dr Vasu Burli|
1. Breath-Holding Spells:
This term has been applied to 2 types of spells.
The 1st is the pallid breath-holding spell, which is the vasovagal reflex usually triggered by dehydration, heat, standing for a long time without movement, hot showers, the sight of blood, pain, or sudden stress.
The 2nd is the cyanotic or, “blue,” breath-holding spell.
Pathophysiology: Spells usually begin between 6 and 18 mo of age.
Triggering factors like Injury, anger, and frustration, particularly with surprise, dehydration, heat, stress and pain.
An episode starts with a cry following a trigger
Prolonged expiratory apnea and reflex vagal cardiac bradycardia
Cyanosis resulting from intrapulmonary shunting
Blurring of vision, Syncope, loss of consciousness and even reflex anoxic seizures may follow.
Management: 1. Education and reassurance of the parents is usually all that is needed, as these episodes are, as a rule, self-limited and outgrown within a few years.
2. Treat coexisting iron deficiency.
3. Anticholinergic drugs (atropine sulfate)
4. Instructing parents in basic cardiopulmonary resuscitation (CPR), or antiepileptic drug therapy for anoxic seizures that are recurrent and not responding to other measures.