A Toddler with Recurrent Episodes of Unexplained Irritability: Will you Consider Neuro Imaging?

Excerpt

A two-and a half-year-old boy, presented with intermittent episodes of irritability for the past six months. A typical episode was characterized by extreme fussiness and intractable crying, which lasted for only 5 to 10 min. His parents tried to pacify him by feeding, rocking and burping but his irritability did not improve despite all attempts during these episodes. Each episode subsided by its own and occurred both in sleep and awake. He had 8 to 10 episodes/day to one episode/month. There were no precipitating or relieving factors. He was being treated as colic by multiple practitioners without any improvement in his symptoms. There was no history of unresponsiveness, seizures, abnormal movements, vomiting and recurrent diarrhea. Systemic and neurological examination was unremarkable. As the child had recurrent brief intractable irritability, a possibility of central nervous system pathology was considered. His electroencephalogram was normal, and a cranial magnetic resonance imaging showed Chairi-1 malformation (Fig. 1). Surgical decompression was planned but parents refused for surgical intervention.

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