Case 2: Severe headache and paroxysmal seizures in a 14-year-old boy with cyclic vomiting syndrome.

Abstract

A 14-year-old boy was admitted to the authors’ hospital due to episodes of intense vomiting that had been recurring for the past three years. Vomiting during attacks occurred >10 times for 1 h to 2 h, and each episode persisted for one to two days. The episodes occurred monthly, but he recovered completely and apeared healthy between episodes. No family history of similar disease, migraine or epilepsy was observed. During the first hospitalization, his blood pressure (BP) was measured multiple times per day and was always normotensive (90/60 mmHg to 100/70 mmHg), and his heart rate was normal. Routine blood laboratory investigations, urine examination, x-ray and sonography of the abdomen, computed tomography (CT) scanning of the brain, electrocardiography, echocardiography and upper gastrointestinal endoscopy were performed, and resulted in no abnormal findings. He was diagnosed with cyclic vomiting syndrome (CVS). Approximately three months later, he was readmitted with complaints of extremely severe headache (Wong-Baker score of 9 to 10) and vomiting for two days, and the first onset of a generalized tonic-clonic seizure. There was no recent history of fever, head trauma or acute illness. His BP was 145/85 mmHg. The remainder of the neurological and general examination was unremarkable except for the severe headache. Further investigations revealed the cause of his symptoms.