Pediatric Patients

The other day I had an eight year old female patient with a chief complaint of vomitting, but a year long history of fainting ("syncope") approximately 20 times. It was strange. We asked all sorts of questions, but as it turns out not enough. She was usually standing up. Her mom had witnessed them and said she would start rocking before she collapsed. She was out for anywhere from 5-20 minutes, depending on who you talked to. Her mom woke her up by splashing water on her face. Her exam was normal. Her ECG was normal. She did not feel palptations. She did get head aches sometimes. She felt nervous sometimes. She had strange stomach aches at times. I thought it might be anxiety or vasovagal related, but it was a wierd history.

Still, the most common serious cause of syncope (in adults at least) is cardiac arrythmias. After having the medical student present the patient to the attendings, they were just as baffled as we were. So we got a cardiology consult. And he asked the right questions.

Turns out she drinks only soda; no water. And that everytime the syncope happens, she gets sweaty and nausous before she passes out. AND that it usually happens when her mom is brushing her hair.

She has "hair grooming" syncope.

I'd never heard of it either. But you can bed I won't forget it now.

Here's a 1988 article abstract:

"Department of Neurology, University of Tennessee College of Medicine, Memphis.

"We report 20 girls who experienced episodes of unconsciousness while standing for hair grooming. The episodes were syncopal in character, electroencephalograms were normal in most cases, and at least 11 of the 20 had definite episodes of syncope in other circumstances. A number of these girls underwent extensive diagnostic testing. We consider this a form of situational or reflex syncope, perhaps related to orthostatic hypotension, the recognition of which may spare unnecessary diagnostic and therapeutic interventions."

So we discharged her. Wierd.

The body does some very odd things sometimes.

Another of my patients, a 16 year old smoking, shrooming, toking, new onset type one diabetic, has this strange disconnect between his peripheral vessels mechanisms to do temperature control and deliver nutrients. Erythromelalgia. He presented with 10/10 pain in both his hands and feet. They were swollen and helped a little by ice packs. Treated with a high blood pressure medicine. He is going home, too.


A couple weeks ago I had an adorable little 4 year old girl with pneumonia, EF. She was in a room with another of my patients, MT, also with pneumonia. M., an 11 year old girl, was on 5 liters of oxygen and still breathing 60 times per minute at times (that's bad). E. was just hanging on to her last half liter of oxygen until, after a couple days, she finally had that weaned off, also. But as it turned out, she was the sicker one in the end.

Her mom was always at her bedside. Her dad and little brother had been in some, also. They were a wonderful family. As I visited them every morning and throughout their days there, we got to know each other better and I liked them more and more. E, would giggle at anything. I started looking up a few jokes for her. When we rounded with the team senior, she was usually eating her breakfast and my senior would tease her about sharing and she never would, as she sopped up some more syrup with the pancakes and shoved it into her mouth with a cute mischevious grin. Her mother smiled adoringly at her side.


to be continued...