A 5-Year-Old Girl With Headache and Vomiting

Afif Harb, MD; Antoine Saliba, MD

Disclosures

February 27, 2018

Physical Examination and Workup

The patient appears pale and icteric. She displays stupor alternating with irritability. Her heart rate is 136 beats/min, blood pressure is 103/62 mm Hg, temperature is 98.06°F, and respiratory rate is 16 breaths/min.

Upon heart examination, regular heart sounds are noted (S1, S2). A grade 2/6 systolic murmur is heard all over the precordium.

The abdomen is soft and nontender, and bowel sounds are positive. The spleen is palpated 3 cm below costal margin.

The patient's cranial nerves are intact. She has normal power and sensation over the right side (upper and lower limbs). She has left-sided hemiparesis and hemianesthesia (upper and lower limbs).

Laboratory findings are as follows:

  • Hemoglobin level: 6.5 g/dL

  • White blood cell count: 24,000 cells/mL

  • Platelet count: 500,000 cells/mL

  • Prothrombin time/partial thromboplastin time: normal

  • Routine chemistry: normal

Results of blood smear examination, high-performance liquid chromatography, and brain CT scan are shown in Figures 1-3.

Figure 1.

Figure 2.

Figure 3.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....