A 5-Year-Old With a Headache, Limp, and Projectile Vomiting

Afif Harb, MD; Antoine Saliba, MD


June 10, 2020

Physical Examination and Work-up

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 (36.7°C), 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 the 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/mcL

  • Platelet count: 500,000 cells/mcL

  • 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.


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