A 5-Year-Old Girl With Headache and Vomiting

Afif Harb, MD; Antoine Saliba, MD

Disclosures

February 27, 2018

Editor's Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 5-year-old girl presents to the emergency department with a severe headache and projectile vomiting for the past 4 hours. Her mother denies any history of trauma to the head or any recent infection or vaccination, and she states that her daughter did not have a fever or chills. Her mother also reports no diarrhea or signs of abdominal pain accompanying the vomiting episodes. She expresses concern that her daughter is barely using her left arm and seems to have developed a limp in her gait recently, mainly supporting herself with her right leg.

The girl's parents are from Kenya. She is the product of a full-term pregnancy and was delivered vaginally, with a negative prenatal and neonatal history. She has been followed by a pediatrician since her delivery and has displayed a normal growth pattern. She has met all developmental milestones with no delays. All vaccinations are up to date.

The patient's mother describes pallor ever since infancy. The girl has had anemia since age 3 years that is being treated with iron supplements and vitamins on an ongoing basis. The patient also had recurrent pain attacks that were treated at home with analgesics. Her mother recalls that her daughter once had swollen, painful hands at age 18 months.

When asked about the family history, the mother reports that she and her husband are unrelated. She states that the patient's 6-month-old brother died of sudden infant death syndrome. In addition, one of the mother's cousins has a transfusion-dependent anemia.

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