Cyclic Vomiting Syndrome LT Greg Gorman. Features Diagnosed 3-6 times a year in tertiary hospitals....
18
Cyclic Vomiting Syndrome LT Greg Gorman
Transcript of Cyclic Vomiting Syndrome LT Greg Gorman. Features Diagnosed 3-6 times a year in tertiary hospitals....
Cyclic Vomiting Syndrome
LT Greg Gorman
Features Diagnosed 3-6 times a year in
tertiary hospitals. 20-30 times a year in Germany
after WW2 Boys and girls equally
Age of Onset
0123456789
10
# of patients
1 3 5 7 9 11 13 15 17
Age (yrs)
Episodes Episodes are similar 85% have uniform length episodes 1-70 episodes per year (avg. 12) 50% have regular cycle
Course in 5 y/o girl
2.5 2.5
2.5
2 2
2
222
27.5 20 27
2926.535
26 42
In hours; green boxes are episodes
Course in 12 y/o girl
1
2 2
2
1/2
11 wks 14 wks
12 wks
10.6 wks
In hours; green boxes are episodes
12th birthday 1st day of school
Parents out of town
Parents went to Dineyland without her
Course in 8 y/o girl
2.5 2.5
2.5
2 2
2
222
27.5 20 27
2926.535
26 42
In hours; green boxes are episodes
Course in 14 y/o boy
2.5 2.5
2.5
2 2
2
222
27.5 20 27
2926.535
26 42
In hours; green boxes are episodes
Duration of Episodes
0
2
4
6
8
10
12
14
16
18
Pati
ents
<6 hrs 6-12 hrs 12-24 hrs 1-2 d 3-4 d 5-7 d Variable
Fleisher, 1993
Timing of Episodes Charateristic timing in 76 %
Usually upon awakening or middle of night
0
5
10
15
20
25
30
DuringNight
Awakening Other NoneFleisher JPGN ‘93
Associated Symptoms Epigastric pain Nausea
Saliva holding Loose stools (30 %) Headache (27 %) Fever (23 %) Occasional hypertension, tachycardia
Associated Symptoms Willingness to drink water
“I drink the water because sometimes vomiting helps to relieve the nausea and, as far as I know I’m going to vomit anyway, it is far less unpleasant to bring up a dilute solution than to vomit concentrated hydrochloric acid…”
Associated Symptoms Triggers (75 %)
Parental conflict (most common) Non-noxious excitement (birthdays
etc) URIs Others:
Menstruation, hot weather, exhaustion, motion sickness, specific foods, asthma attacks
Family History IBS (67 %) (2-6x normal
prevalence) Migraine (11%) Motion Sickness (46%) Type A Personality (76%) Epilepsy (6%) (10x normal
prevalence)
Course Over half symptom free 1 yr later Others last decades ? End at puberty
Pathogenesis Migraine equivalent
Fits pattern and family history Eipileptic equivalent
Case report of 5 seizure patients with CVS pattern
Differential Diagnosis Brain Stem Glioma Obstructive Uropathy Others
Management Anti-emetics Induction of sleep Resolution with consultation alone Psychosocial support
