Medical treatment includes steroids and acetazolamide, as well as anticoagulation for venous sinus thrombosis. Frequent ophthalmological/neurological follow-up is necessary, with intracranial pressure (ICP) monitoring for a decision on lumboperitoneal shunting if headaches are intractable. Frequent ophthalmological/neurological follow-up is necessary, with ICP monitoring for a decision on lumboperitoneal shunting if headaches are intractable. Optic nerve fenestration may be required if there is visual deterioration. Quality of life is often compromised by learning difficulties following radiotherapy as well as neurological disability. Endocrine deficits may be the result of tumour, surgery and/or radiotherapy. The majority of children who deteriorate neurologically and cognitively do not have a recognisable degenerative disease. Fifteen percent of children presenting with acute focal neurological signs suggestive of arterial ischaemic stroke have alternative aetiologies example cerebral venous sinus thrombosis, hemiplegic migrane, metabolic disease. A simple analgesic can be prescribed the child knows the migraine is starting.