Toddler migraines related to a cyst in brain and syrinx??

[cq]

Our 17-month-old daughter has “episodes” of intense vomiting during which she will scream in pain and her head will tilt to her left as if it is too heavy to hold up. In between the vomiting she will lie very still,  she is always cold and clammy during these episodes.  She has them on average once a month or so and they last around 4 hours. She will dry heave on average about 12 times and when she does this she screams in pain. She “snaps” out of them and then appears as if nothing was wrong.  They come on without warning as well.

She has had numerous tests done such as an upper GI, barium enema, metabolic blood tests, cat scans, MRI’s, and EEGs. At first it was thought she had CVS, but then it was thought it might be a neurological issue. Migraines or seizures???

Her latest MRI showed a posterior fossa fluid collection which is likely a prominent cisterna magna as opposed to an isolated arachnoid cyst.  There was normal CSF low dynamics at the craniocervical junction. She also has a syrinx between the T5 and T8. She is not walking on her own yet. She is able to walk behind a walker though.  She appears well in between these episodes.  She recently underwent a 48-hour video EEG which the results did not show any seizure activity, although she didn't have an episode during this time.  Do you think she could be having migraines related to the cisterna magna and syrinx?  We are scheduled to see a neurosurgeon again.  Any thoughts as to what are causing her “episodes?” Should we be concerned with the cisterna magna and syrinx at this point? Thank you for your input.

[CCF-Neuro-M.D.-CS]

Without evaluating your daughter I cannot make a clinical diagnosis. Possible causes for this intermittent problem could include migraine variant (such as cyclic vomiting) and seizures. The posterior fossa cyst versus cisterna magna needs to be considered as well. A non-communicating cyst near the brain stem can intermittently expand and cause similar symptoms. It would be reasonable to have this evaluated by a Neurosurgeon, specifically one who specializes in cysts. If you are in the area, Dr Luciano is our expert. It is hard to blame the syrinx for this problem. A complete evaluation by a pediatric neurologist and neruosurgeon at an academic center would be reasonable. Then a comprehensive plan of care can be arranged. Good luck.

[sidm]

I will pray for you, your spouse, and you daughter.  You are not alone.