A Child Presenting With Headache and Periorbital Bruising

Abstract

Aim: This study aimed to introduce a patient with a rarely encountered case of recurrent dark discoloration. Case: A 12-year-old girl.Her headaches started 2 weeks ago.When she has headache,a rash followed by darkening and then bruising around her both eyes appear.When her headache wears off the bruising disappears.She has nausea but does not vomit.In her family,her uncle has a history of migraine.No history of kin marriage between her mother and dad.No history of hospitalization.She had dark discoloration 5 times in 2 weeks and presented to the emergency department. Headache has no localization.She feels the pain all over her head and it lasts whole day.No history of alcohol or drug abuse.Her headache is not triggered by any food or drink.When the bruising occurs her vision becomes blurry.She has photophobia and phonophobia.She cannot sleep because of her headache and sleeplessness increases her complaints.She has missed several days of school.She spends too much time on phone and computer.She has stress and crying spells. Her neurological examination is normal.Fundus examination is natural and there is no papilledema.She does not have opsoclonus,myoclonus or nystagmus.The EEG,brain MRG and MR venography are normal.She does not have anemia and the labs are normal.Pseudotumor cerebri,neuroblastoma or allergic reaction were not considered.Propranolol and fluoxetine was commenced for migraine prophylactic treatment and the patient's headache improved And she is still followed-up. Conclusion: Co-occurrence of dark discoloration and headache are reported with trigeminal autonomic cephalgia,neuroblastoma, sinus vein thrombosis,idiopathic intracranial hypertension,amyloidosis and aplastic anemia in the literature.However,these recurrent symptoms are predominantly associated with migraine.

Keywords

• periorbital dark discolaration
• headache
• migraine