Recurrent Head Pressure and Vomiting in Children

Headache and vomiting?

Hello Doctor, my 12-year-old child has recently experienced episodes of head swelling and vomiting as follows: Note: On January 18, he received an injection in the endocrinology department to suppress bone age growth for a duration of three months.

1.
On January 25, after eating, he experienced head swelling and vomiting (occasionally with right-hand numbness, weakness in limbs, and slight flashes of light in his vision).
He went to the emergency room where X-rays and blood tests were normal.
He received IV saline and antiemetic medication, but after four hours of trying to eat, he still vomited.
He was discharged after a total of seven hours.
2.
On February 3, the same symptoms recurred, and he returned to the emergency room.
He received IV fluids, but vomiting continued.
Unless it was a gastrointestinal issue, the doctor decided to use medication to reduce intracranial pressure (Anlotinib injection), which restored normalcy and stopped the vomiting.
He was then admitted to the hospital (endocrinology department), where X-rays and blood tests were again normal, and he was discharged for observation.
3.
On March 28, the same symptoms occurred again, and we went through the same process.
The emergency physicians have suggested that it might be a gastrointestinal issue, but the frequency of these episodes is concerning.
Which direction should we seek for further evaluation?

Ms. Wu, 40~49 year old female. Ask Date: 2024/03/28

Dr. Xie Wanghu reply Pediatrics

Hello Ms.
Wu,
The side effects of Leuplin can include rash, wheezing, chest tightness, difficulty breathing, and difficulty swallowing or speaking, as well as gastrointestinal discomfort.
Many cases of gastroenteritis can present with symptoms such as vomiting, diarrhea, and fever, which may occur simultaneously or develop progressively.
What is concerning is whether there is a need for a head MRI to rule out the possibility of an intracranial tumor.
It is advisable to first exclude this possibility before considering gastroenteritis and then reassessing whether the symptoms are side effects of Leuplin.
I hope this information is helpful to you.
Thank you.

Reply Date: 2024/03/28

More Info

It sounds like your 12-year-old child is experiencing recurrent episodes of head pressure and vomiting, which can be concerning and disruptive to their daily life. Given the history of symptoms and the treatments received, it’s important to consider several potential underlying causes and the appropriate next steps for evaluation and management.

Understanding the Symptoms
The symptoms you describe—head pressure, vomiting, occasional right-hand numbness, weakness in the limbs, and visual disturbances—could be indicative of several conditions. The fact that these episodes have occurred multiple times, with similar presentations, suggests that there may be an underlying issue that needs to be addressed.

1. Intracranial Pressure: The use of medications to lower intracranial pressure (ICP) during hospital visits indicates that your child's symptoms may be related to elevated ICP. This can happen due to various reasons, including but not limited to, intracranial hypertension, idiopathic intracranial hypertension (IIH), or even complications from previous medical treatments.

2. Gastrointestinal Issues: While the emergency physicians have suggested gastrointestinal problems, the recurrent nature of the symptoms, especially the head pressure and neurological signs (like numbness and visual disturbances), raises the possibility of a neurological component that should not be overlooked.

3. Neurological Evaluation: Given the recurrent nature of these episodes, it would be prudent to consult a pediatric neurologist. They can perform a thorough evaluation, which may include imaging studies such as an MRI of the brain to rule out any structural abnormalities, as well as further neurological assessments to evaluate the function of the nervous system.

4. Endocrine Considerations: Since your child has been receiving treatment from an endocrinologist to suppress bone age growth, it’s also essential to consider whether there could be any hormonal or metabolic factors contributing to these symptoms. Hormonal imbalances can sometimes lead to headaches and other neurological symptoms.

Recommended Next Steps
1. Pediatric Neurology Consultation: Schedule an appointment with a pediatric neurologist as soon as possible. They will be able to assess the neurological symptoms in detail and may recommend further testing, such as an MRI or a lumbar puncture, to measure cerebrospinal fluid (CSF) pressure.

2. Keep a Symptom Diary: Document each episode, including the timing, duration, associated symptoms, and any potential triggers (such as food intake, stress, or physical activity). This information can be invaluable for the healthcare provider in determining the pattern and potential causes of the symptoms.

3. Follow-Up with Endocrinology: Continue to follow up with the endocrinologist to monitor any potential side effects of the treatment being administered and to ensure that there are no hormonal issues contributing to the symptoms.

4. Emergency Plan: Given the severity of the symptoms, it may be helpful to have a plan in place for when these episodes occur, including when to seek emergency care and what information to provide to healthcare providers.

Conclusion
In summary, the recurrent episodes of head pressure and vomiting in your child warrant a comprehensive evaluation by a pediatric neurologist, along with continued monitoring by the endocrinologist. It’s crucial to address both the neurological and potential endocrine aspects of your child’s health to ensure a thorough understanding of their condition and to develop an effective management plan. Early intervention and appropriate referrals can lead to better outcomes and improved quality of life for your child.

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