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Cyclic Vomiting Syndrome

Cyclic Vomiting Syndrome. LT Greg Gorman. Features. Diagnosed 3-6 times a year in tertiary hospitals. 20-30 times a year in Germany after WW2 Boys and girls equally. Age of Onset. Episodes. Episodes are similar 85% have uniform length episodes 1-70 episodes per year (avg. 12)

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Cyclic Vomiting Syndrome

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  1. Cyclic Vomiting Syndrome LT Greg Gorman

  2. Features • Diagnosed 3-6 times a year in tertiary hospitals. • 20-30 times a year in Germany after WW2 • Boys and girls equally

  3. Age of Onset

  4. Episodes • Episodes are similar • 85% have uniform length episodes • 1-70 episodes per year (avg. 12) • 50% have regular cycle

  5. Course in 5 y/o girl 20 27 27.5 2.5 2.5 2 2 29 35 26.5 2.5 2 26 42 2 2 2 In hours; green boxes are episodes

  6. Course in 12 y/o girl 11 wks 14 wks 2 2 12th birthday 1st day of school 12 wks 1 2 Parents out of town 10.6 wks 1/2 Parents went to Dineyland without her In hours; green boxes are episodes

  7. Course in 8 y/o girl 20 27 27.5 2.5 2.5 2 2 29 35 26.5 2.5 2 26 42 2 2 2 In hours; green boxes are episodes

  8. Course in 14 y/o boy 20 27 27.5 2.5 2.5 2 2 29 35 26.5 2.5 2 26 42 2 2 2 In hours; green boxes are episodes

  9. Duration of Episodes Fleisher, 1993

  10. Timing of Episodes • Charateristic timing in 76 % • Usually upon awakening or middle of night Fleisher JPGN ‘93

  11. Associated Symptoms • Epigastric pain • Nausea • Saliva holding • Loose stools (30 %) • Headache (27 %) • Fever (23 %) • Occasional hypertension, tachycardia

  12. Associated Symptoms • Willingness to drink water • “I drink the water because sometimes vomiting helps to relieve the nausea and, as far as I know I’m going to vomit anyway, it is far less unpleasant to bring up a dilute solution than to vomit concentrated hydrochloric acid…”

  13. Associated Symptoms • Triggers (75 %) • Parental conflict (most common) • Non-noxious excitement (birthdays etc) • URIs • Others: • Menstruation, hot weather, exhaustion, motion sickness, specific foods, asthma attacks

  14. Family History • IBS (67 %) (2-6x normal prevalence) • Migraine (11%) • Motion Sickness (46%) • Type A Personality (76%) • Epilepsy (6%) (10x normal prevalence)

  15. Course • Over half symptom free 1 yr later • Others last decades • ? End at puberty

  16. Pathogenesis • Migraine equivalent • Fits pattern and family history • Eipileptic equivalent • Case report of 5 seizure patients with CVS pattern

  17. Differential Diagnosis • Brain Stem Glioma • Obstructive Uropathy • Others

  18. Management • Anti-emetics • Induction of sleep • Resolution with consultation alone • Psychosocial support

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