Visual Diagnosis: Acute-Onset Headache, Vertigo, and Torsional Nystagmus in a 13-year-old Boy
| Autor: | Helen C. Wu, Amanda Weber, Asri Yuliati |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
Hemangioma Cavernous Central Nervous System Adolescent Photophobia Physical examination Nystagmus Nystagmus Pathologic 03 medical and health sciences 0302 clinical medicine 030225 pediatrics Vertigo Middle Cerebellar Peduncle medicine Brain Stem Neoplasms Humans Medical history 030212 general & internal medicine medicine.diagnostic_test biology business.industry Headache Emergency department medicine.disease biology.organism_classification Magnetic Resonance Imaging Phonophobia Migraine Anesthesia Pediatrics Perinatology and Child Health medicine.symptom business |
| Zdroj: | Pediatrics In Review. 40:e22-e24 |
| ISSN: | 1526-3347 0191-9601 |
| Popis: | 1. Helen Wu, MS* 2. Amanda Weber, DO† 3. Asri Yuliati, MD† 1. *MD/PhD Program, and 2. †Department of Neurology, Children’s Hospital of Michigan, Detroit Medical Center, Wayne State University School of Medicine, Detroit, MI A 13-year-old boy presents to the emergency department with a 4-day history of new-onset severe bifrontal aching headache with associated nausea, vomiting, photophobia, phonophobia, and vertigo. He had been evaluated at another institution twice in the preceding 4 days for the same complaint, and he failed outpatient management with naproxen and meclizine. His previous medical history is unremarkable. He denies drug use. The emergency department administers a migraine cocktail consisting of ketorolac, diphenhydramine, and prochlorperazine, which results in significant pain improvement, but the vertigo persists. On physical examination, vital signs and results of pulmonary, cardiac, gastrointestinal, and skin examinations are normal. He is awake, alert, and oriented. His neurologic examination is remarkable for a rightward head tilt, torsional nystagmus (Video), dysmetria with finger-to-nose evaluation greater on the left, and difficulty with tandem gait. He is able to ambulate independently. Reflexes and sensory examination findings are normal. Due to nystagmus, the funduscopic examination cannot be completed. Basic laboratory electrolyte panel and complete blood cell count are noncontributory. Magnetic resonance imaging (MRI) is ordered emergently and reveals the diagnosis. Video. The patient demonstrated subtle rotational nystagmus with leftward fast component. Based on his physical examination and laboratory findings, the differential diagnosis for the patient’s complaints includes a brainstem or cerebellar stroke, mass, vascular … |
| Databáze: | OpenAIRE |
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