Confused episodes

by Vivienne Nolan
(Sacramento CA USA)

Child Migraine

My 7 year old daughter has had 2 confused episodes in the last 6 months. She feels dizzy, strange, gets blurred vision,her pupils are much enlarged, she is confused, difficulty grasping objects and understanding instructions, nausea, fatigue. She suffers these for 4 to 5 hours. She falls asleep and wakes up normal but tired. She is completely back to normal mental speed after a few weeks.

We do not know what it is, we have been to see a Neurologist and he doesn't know if its seizures or migraines. We have done an MRI with and without contrast and a 24hr EEG- nothing,2 CAT scans showed a cyst which later was called a misread, the MRI did not show a cyst, after the most recent confused episode the Neurologist has ordered another MRI (more resolution this time) and another EEG for 3 day time period. If it is migraines or seizures what other scans and tests can we do to determine what it is for sure?

Answer:

Hi Vivienne,

From what you have described, your neurologist is on the right track. Sometimes with a new diagnosis of seizures..nothing shows up on tests unless a seizure is actually captured while EEG monitoring is done. Additionally with the 3 day EEG you might consider asking the doctor if it is available as a video monitored EEG.

At age 7, a diagnosis of migraine generally doesn't show much on the MRI and it sounds like she has had enough imaging done as far as that is concerned.

There is such a thing as confusional migraine in children, but you do not mention if her head hurts. With nausea and any abdominal pain, abdominal migraine or stomach migraines is also a possibility.

Keep working with the neurologist. If she has more episodes, the doctor may consider medication for awhile which will help the brain "settle" down so to speak.

Best of luck!
Mary Kay Betz MS RPA-C