Case 10: A 5-Year-Old Boy With Sudden Onset of Vomiting and Inability to Walk

Presenter: Kaleb Yohay, MD, Chief Resident, Pediatric Neurology, Johns Hopkins Hospital, Baltimore, MarylandPreceptor: Rebecca N. Ichord, MD, Assistant Professor, Johns Hopkins Hospital, Baltimore, Maryland 

January 16, 2002

In This Article

Case Presentation

The patient is a 5-year-old right-handed white boy with no significant past medical history. On the day of presentation, he was in his usual state of good health. In the morning he played basketball with friends. He returned home for lunch but, unusually, had no appetite and complained of dizziness; he subsequently vomited. He slept most of the afternoon, but continued to experience intermittent emesis. That night, when he tried to get to the bathroom on his own, he fell and was unable to walk without assistance. He was very unsteady, and in the bathroom he fell again. Later that night, he was pale, "didn't look right," continued to be unsteady on his feet, and vomited repeatedly. He was taken by ambulance to a community hospital.

At the emergency room, basic metabolic and hematologic laboratory profiles were performed and found to be normal. An abdominal ultrasound was also normal. He was diagnosed with viral gastroenteritis and dehydration, and was admitted to the pediatric ward at 4 am. He continued to vomit frequently. Later that morning, he was evaluated by a pediatrician who noted that he had a wide-based, ataxic gait. A head CT was obtained, revealing a posterior fossa mass. At that time, he was transferred to our hospital for neurosurgical evaluation.

Past Medical History

The patient had been delivered as a healthy infant at full term after an uncomplicated pregnancy and delivery. He achieved developmental milestones appropriately. At 2 years of age, he had suffered a minor head injury without loss of consciousness and required scalp sutures. His immunizations are up-to-date.

Review of Systems

The patent had been treated with antibiotics for a possible pneumonia 2 weeks before this presentation. Review of systems is otherwise negative.

Family History

The patient has 2 healthy brothers, 8 and 10 years old, and likewise healthy parents. His maternal grandfather has a history of atrial fibrillation, and is taking Coumadin. His paternal grandfather had a myocardial infarction at age 60. His maternal great-grandfather suffered a stroke in old age. His maternal great-grandmother had a deep vein thrombosis in old age. The family has no history of cancer, miscarriages, strokes in the young, ataxia, or coagulopathy.

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