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Hallucinations in Pediatrics
- 2. Khalaf A. Sayed Assistant lecturer of pediatrics
- 3. Hallucinations are perceptions (auditory, visual, tactile, or olfactory) that occur in the absence of external stimuli. Hallucinations occurring in adolescence are more indicative of psychopathology than hallucinations during childhood. In children, hallucinations can be part of normal development or can be associated with nonpsychotic psychopathology or psychosocial stressors.
- 5. A 5-year-old boy was hospitalized because of fever, confusion and hallucinations, which included seeing his teacher and classmates near him and talking to them. CBC: lecocytosis CSF examination : normal Urine drug screen : acetaminophen MRI brain :normal
- 7. Suspect CNS Infection if : Abnormal neurological findings such as Meningeal signs Disturbed consciousness Focal neurological signs Marked slowing in the awake EEG background activity.CSF examination is the gold slandered for diagnosis
- 8. A 6-year-old boy came to ER at night because of agitation, insomnia and sensing insects and beasts crawling on the body. He was afebrile. He received mediation for nocturnal enuresis (oxybutynin) last few days. Normal neurological examination.
- 11. A 5-year-old girl came to ED complaining of seeing, feeling, and hearing bees on her pillow. All medications in the house were kept out of the girl. Her physical examination, including her vital signs, was within normal limits, including a neurologic examination. She persisted in reporting having ‘‘bees in my pants, in my socks’’ and repeatedly searched under her shirt and pant-legs for them. She was not reassured by parental attempts to show her nothing was on her body or in her clothes. She was discharged 2 days later after symptomatic improvement, negative physical and laboratory
- 12. Young age (2-6 y)1 Often visual or tactile 2 Last 10-60 minutes 3 Afebrile, Alert4 Prominent at night 5 Convey complaints clearly 6 Attempts to remove insects, snakes 7 8 Fear not alleviated by reassurance Fear not amenable to reason 9 No history of abuse, medication ingestion 10 Normal physical examination 11 Persist for 1-3 days, slowly abating over 1-2 wk 12 Acute Phobic Hallucinations of Childhood
- 13. A 5-year-old boy came to ED complaining of seeing snakes and spiders crawling on his legs and arms at nigh. The attack lasts for 15 minutes with intense fear ,repeated 4 times, followed by deep sleep. history of recurrent nocturnal attacks of fear characterized by unresponsiveness during the attacks of short duration. Findings of a neurologic examination including routine and sleep-deprived (EEG) and MRI brain were normal . Video-EEG in the next night shows similar 5 attacks associated with right temporal spikes.
- 15. Frontal Lobe Epilepsy Late-onset, "Gastaut type", childhood occipital epilepsy
- 16. Gradual onset , lasts 5 to 30 m uncolored, unilateral small dots and zigzag lines line in the center of the visual field gradually progresses toward the periphery, often leaving a scotoma, Idiopathic occipital epilepsy vs migraine Develop in seconds, usually last for 1–3 min, Small, brightly colored circular. Distorted in size or it may suddenly change shape . Moving from a lateral field toward the center of the field of vision occipital seizures Migraines
- 17. Elementary visual hallucinations as perceived and drawn by eight of the nine patients with IOEVH C P Panayiotopoulos J Neurol Neurosurg Psychiatry 1999;
- 18. Mental status examination Evaluation of hallucinations History of seizures History of headache History of fever or drug intake Relation to sleep A y of seizures eadache ex partial y hic occipital y of Gastaut e umor B Mental us ic ions ors bic ions Cs andD a
- 19. Thank s A Lot
Editor's Notes
- (A) Elementary visual hallucinations as perceived and drawn by eight of the nine patients with IOEVH. First and second row from left to right: the illustrations of patients 1 to 6 are consecutively presented. Third row from left to right: the illustrations of patient 7 (left) and 8 at onset (middle) and just before progressing to loss of consciousness and GTCS (right). (B) From video-EEG recordings. First row: high amplitude occipital paroxysms from video-EEG of patient 3. They were immediately activated by closing the eyes and persisted as long as the eyes were closed. Opening the eyes immediately eliminated the occipital paroxysms for as long as the eyes were opened. The occipital paroxysms were similarly activated in conditions of elimination of fixation and central vision (darkness, vision through goggles covered with semitransparent tape) and inhibited in conditions that these were preserved (fixation off sensitivity). Second row: low amplitude, occipital fast rhythms intermixed with spikes from video-EEG of patient 6. These occurred immediately after closing the eyes. They did not persist during the remaining period that the eyes were closed. Contrary to the occipital paroxysms of patient 3, they were eliminated in darkness and the patient also had time locked occipital spikes induced by intermittent photic stimulation.