In children with facial nerve palsy caused by Lyme disease, there may be bilateral involvement in contrast to Bell palsy, in which weakness is always unilateral Additionally, facial nerve palsy can be the sole presenting symptom of Lyme disease Thus, even in the absence of other findings, serologic evidence for systemic Lyme infection should be sought in all children with isolated cranial nerve VII paresis in endemic areas The sensitivity of serologic testing increases with time after infection, so repeat titers are indicated in circumstances where suspicion is high but initial titers are negative An LP should be performed if there is evidence of meningoencephalitis such as severe headache or nuchal rigidity; however, the need for LP in a child at risk for Lyme disease with isolated facial nerve palsy is controversial For patients with facial nerve palsy due to Lyme disease, oral antibiotic treatment for 14 to 21 days is indicated as for other manifestations of early-disseminated Lyme disease (see Chapter 94 Infectious Disease Emergencies ) Parenteral antibiotics are reserved for those with findings of meningitis The effectiveness of steroids in such patients has not been evaluated Suggested Readings and Key References Seizures Bye A, Kok D, Ferenschild F Paroxysmal non-epileptic events in children: a retrospective study over a period of 10 years J Paediatr Child Health 2000;36(3):244–248 Committee on Quality Improvement; Subcommittee on Febrile Seizures Clinical practice guideline: febrile seizures: guideline for the neurodiagnostic evaluation of the child with a simple febrile seizure Pediatrics 2011;127:389– 394 Glauser T, Shinnar S, Treiman DM, et al Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the Guideline Committee of the American Epilepsy Society Epilepsy Curr 2016;16(1):48– 61 Lyons TW, Johnson KB, Kimia AA, et al Yield of emergent neuroimaging in children with new-onset seizure and status epilepticus Seizure 2016;35:4–10 Rivello JJ, Ashwal S, Hirtz D, et al Practice parameter: diagnostic assessment of the child with status epilepticus (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society Neurology 2006;637:1542–1550 Migraine Gelfand AA, Goadsby PJ Treatment of pediatric migraine in the emergency room Pediatr Neurol 2012;47:233–241 Kaar CR, Gerard JM, Nakanishi AK The use of a pediatric migraine practice guideline in an emergency department setting Pediatr Emerg Care 2016;32(7):435–439 Richer L, Billinghurst L, Hartling L, et al Drugs for the acute treatment of migraine in children and adolescents Cochrane Database Syst Rev 2016;4:CD005220 Idiopathic Intracranial Hypertension Matthews YY, Dean F, Kennedy CR, et al Pseudotumor cerebri syndrome in childhood: incidence, clinical profile and risk factors in a national prospective population-based cohort study Arch Dis Child 2017;102(8):715–721 Moavero R, Sforza G, Valeriani M, et al Clinical features of pediatric idiopathic intracranial hypertension and applicability of new ICHD-3 Criteria Front Neurol 2018;9:819 Stroke Mackay MT, Yock-Corrales A, Churilov L, et al Differentiating childhood stroke from mimics in the emergency department Stroke 2016;47(10):2476–2481 Monagle P, Chan AC, Goldenberg NA, et al Antithrombotic therapy in neonates and children Chest 2012;141(2 suppl):e737S–e801S Rivkin MJ, deVeber G, Ichord RN, et al Thrombolysis in pediatric stroke study Stroke 2015;46(3):550–555 Roach ES, Golomb MR, Adams R, et al Management of stroke in infants and children Stroke 2008;39:2644–2691 Stroke in childhood Clinical guidelines for diagnosis, management and rehabilitation 2017 Available online at https://www.rcpch.ac.uk/sites/default/files/201807/2017_stroke_in_childhood_-_guideline_final_3.6.pdf Accessed April 15, 2019 Encephalitis Dalmau J, Graus F Antibody-mediated encephalitis N Engl J Med 2018;378:840–851 Hasbun R, Wootton SH, Rosenthal N, et al Epidemiology of meningitis and encephalitis in infants and children in the United States, 2011–2014 Pediatr Infect Dis J 2019;38(1):37–41 Thompson C, Kneen R, Riordan A, et al Encephalitis in children Arch Dis Child 2012;97:150–161 Tunkel AR, Glaser CA, Bloch KC, et al; 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PJ Treatment of pediatric migraine in the emergency room Pediatr Neurol 2012;47:233–241 Kaar CR, Gerard JM, Nakanishi AK The use of a pediatric migraine practice guideline in an emergency department... differential diagnosis and evaluation in the emergency department Pediatr Neurol 2016;65:14–30 Garone G, Reale A, Vanacore N, et al Acute ataxia in paediatric emergency departments: a multicentre Italian... M, Kannikeswaran N, Sivaswamy L, et al Utility of neuroimaging in children presenting to a pediatric emergency department with ataxia Pediatr Emerg Care 2019;35:335–340 Benign Paroxysmal Vertigo