Pediatrik Nöroloji Pratiğinde Kusma: Etiyolojik Spektrum ve Klinik Etkileri

Öz

Çocukluk çağında kusma çoğunlukla benign gastrointestinal nedenlere bağlanmakla birlikte, özellikle persistan veya tekrarlayan olgularda nörolojik etiyolojiler de akılda tutulmalıdır. Bu çalışmada, çocuk nöroloji polikliniğine bulantı ve/veya kusma şikâyeti ile başvuran hastaların etiyolojik dağılımı, klinik özellikleri ve tanısal bulgularının değerlendirilmesi amaçlandı. Bu retrospektif çalışmada, Ekim 2022–Aralık 2025 tarihleri arasında başvuran 0–17 yaş arası 107 hastanın tıbbi kayıtları incelendi. Hastaların demografik özellikleri, kusmanın süresi ve sıklığı, eşlik eden semptomlar, nörolojik muayene bulguları, yapılan tanısal incelemeler (EEG ve nörogörüntüleme) ve son tanıları analiz edildi. Hastaların ortanca yaşı 9 yıl olup %52,3’ü kızdı. Kusma süresi hastaların %43,9’unda altı aydan uzun, %72,9’unda ise haftada en az bir kez olacak şekildeydi. Nörolojik muayene hastaların %92,5’inde normal bulundu. Nörogörüntüleme %87,9 hastada yapılmış olup %17,2’sinde anormallik saptandı; bu bulguların büyük kısmı insidental veya nonspesifik özellikteydi. En sık son tanı reflü/gastrit (%36,4) olarak belirlenirken, bunu siklik kusma sendromu (%18,7) ve migren (%8,4) izledi. Nörolojik nedenler arasında epilepsi (%3,7), demiyelinizan hastalık (%2,8), psödotümör serebri (%2,8) ve intrakraniyal kitle/kanama (%0,9) yer aldı. Çocuk nöroloji polikliniğine kusma nedeniyle başvuran hastaların çoğunda etiyoloji benign olmakla birlikte, klinik açıdan önemli bir azınlıkta santral sinir sistemi kaynaklı nedenler saptanabilmektedir. Bu nedenle dikkatli nörolojik değerlendirme ve uygun tanısal yaklaşım gereksiz görüntülemeleri azaltırken ciddi altta yatan patolojilerin erken tanınmasına katkı sağlayabilir.

Anahtar Kelimeler

• bulantı
• kusma
• epilepsi
• psödotümör serebri
• siklik kusma

Vomiting in Pediatric Neurology Practice: Etiological Spectrum and Clinical Implications

Öz

Vomiting in children is commonly attributed to benign gastrointestinal causes; however, neurological etiologies must be considered, particularly in persistent, recurrent, or atypical cases. This study aimed to evaluate the clinical spectrum, etiological distribution, and diagnostic findings of pediatric patients presenting with nausea and/or vomiting to a pediatric neurology outpatient clinic. In this retrospective study, medical records of 107 patients aged 0–17 years who presented between October 2022 and December 2025 were reviewed. Demographic characteristics, clinical features, neurological examination findings, EEG and neuroimaging results, and final diagnoses were analyzed.The median age was 9 years, and 52.3% of patients were female. Vomiting duration exceeded six months in 43.9% of cases, and 72.9% experienced vomiting at least weekly. Neurological examination was normal in 91.5% of patients. Neuroimaging was performed in 87.9%, with abnormalities detected in 17.2%, most of which were incidental or non-specific. The most frequent diagnoses were reflux/gastritis (36.4%) and cyclic vomiting syndrome (18.7%), followed by migraine (8.5%) and psychiatric etiologies (8.5%). Neurological causes included epilepsy (3.7%), demyelinating disease (2.8%), and pseudotumor cerebri (2.8%).Although vomiting in pediatric neurology practice is often benign, central nervous system etiologies are present in a clinically meaningful proportion. Identification of neurological “red flag” features—such as abnormal neurological examination, papilledema, ataxia, morning vomiting, and altered consciousness—is essential to guide appropriate neuroimaging and referral decisions while avoiding unnecessary investigations.

Anahtar Kelimeler

• nausea
• vomiting
• epilepsy
• pseudotumor cerebri
• cyclic vomiting

Kaynakça

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