PDF(Pubmed)
Abstract：
BACKGROUND: Pediatric headache is a common cause of pediatric emergency department (ED) visits, and 8.8% of cases require imaging. Alarmingly, 12.5% of imaged cases have a pathologic cause. A pediatric patient with a complicated medical history presented to the pediatric ED with multiple cerebral abscesses. The possible causes and contributors to this rare cause of pediatric headache and a review of pediatric headache emergency management are presented.Case Presentation: A 12-year-old male patient with a complex medical and surgical history, including post-repair pulmonary valve stenosis, visited the pediatric ED for intractable and worsening left frontoparietal headache, refractory to ibuprofen, for 6 days. A physical examination revealed severe photophobia and restlessness secondary to severe head pain. Non-contrast brain computed tomography demonstrated two round, bilateral, parietal hypodense lesions with surrounding vasogenic edema. The lesions were consistent with abscesses on magnetic resonance imaging. Eventually, the patient underwent successful surgical abscess drainage and made a full recovery. The patient was lost to follow-up; therefore, no causative bacterial species was determined.
CONCLUSIONS: Managing pediatric headache in emergency settings requires a robust history and physical examination. Cerebral abscesses are an infrequent but fatal cause of pediatric headache and therefore should be considered among the differential diagnoses.
CONCLUSIONS: Managing pediatric headache in emergency settings requires a robust history and physical examination. Cerebral abscesses are an infrequent but fatal cause of pediatric headache and therefore should be considered among the differential diagnoses.
摘要：
背景：小儿头痛是儿科急诊科（ED）就诊的常见原因，8.8%的病例需要成像。令人震惊的是,12.5％的成像病例具有病理原因。一位患有复杂病史的儿科患者出现在患有多发性脑脓肿的儿科ED上。介绍了小儿头痛的这种罕见原因的可能原因和贡献者，以及小儿头痛急诊管理的综述。病例介绍：一名12岁男性患者，有复杂的医疗和手术史，包括修复后肺动脉瓣狭窄,对小儿ED进行了难治性和恶化的左额顶头痛，布洛芬难治,6天。体格检查显示严重的畏光和躁动继发于严重的头部疼痛。非对比脑计算机断层扫描显示两轮，双边,顶叶低密度病变伴周围血管源性水肿。磁共振成像显示病灶与脓肿一致。最终,患者成功进行了脓肿引流术，并完全康复。病人失去了随访；因此，没有确定致病细菌种类。
结论：在紧急情况下管理小儿头痛需要可靠的病史和体格检查。脑脓肿是小儿头痛的罕见但致命的原因，因此应在鉴别诊断中考虑。
结论：在紧急情况下管理小儿头痛需要可靠的病史和体格检查。脑脓肿是小儿头痛的罕见但致命的原因，因此应在鉴别诊断中考虑。
