Pediatric emergency medicine trisk 2650 2650
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Pharmacologic treatment of chorea can be difficult and unpredictable.
Prednisone has been shown in both retrospective and prospective control trials to
decrease overall duration of chorea and to shorten time to full remission.
Haloperidol (0.5 to 1 mg PO twice daily) has been reported to result in
improvement within 2 to 3 days. Multiple antiepileptic agents including VPA and
carbamazepine have also been used. Case reports have described the use of IV
immunoglobulin and plasmapheresis in refractory cases.
Tics
Tics are another form of involuntary movement that manifest as stereotyped,
intermittent motor movements or vocalizations. They may be extremely difficult
to distinguish from chorea and are best differentiated by their stereotypic
character. In contrast to chorea, tics may persist during sleep. They probably
represent the most common involuntary movement disorder but are not true
neurologic emergencies. For most children, tics are transient and will not require
treatment.
DISORDERS OF CRANIAL NERVE FUNCTION
Goals of Treatment
Disorders of cranial nerve function typically present with classic patterns of
neurologic dysfunction. Therefore, specific attention should be paid to
completing a full cranial nerve examination and obtaining a clinical history
suggestive of alterations of sensation. Identifying the pattern of cranial nerve
involvement will determine the necessary evaluation and the likely etiology.
CLINICAL PEARLS AND PITFALLS
Optic neuritis is associated with both decreased visual acuity and
decreased color vision.
Facial nerve palsy with isolated upper motor neuron involvement is
associated with some residual capacity to furrow the brow because of
crossed innervation.
Systemic corticosteroids have been shown to improve the likelihood of
complete resolution of idiopathic facial nerve palsy.
Lyme disease may be the most common cause of facial nerve palsy in
endemic areas and testing is recommended.
