What’s Your Diagnosis? Life-Threatening Secondary Headaches in Pediatric Patients

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got the previous case on Pediatric Electrolyte Emergencies: Recognition and Management in the Emergency Department right.

Case Presentation:  An Evidence-Based Review of Life-Threatening Secondary Headaches in Pediatric Patients in the Emergency Department 

A 4-year-old previously healthy girl is brought into the emergency department by her mother for 6 days of vomiting and headache… 

The child has woken up several times over the last week holding her head, crying, and vomiting nonbloody, nonbilious emesis. The girl’s brother is sick with viral gastroenteritis; however, the mother says the girl has not had diarrhea or fever. 

The girl’s vital signs are: temperature, 37°C; heart rate, 69 beats/min; respiratory rate, 30 breaths/min; and blood pressure, 120/64 mm Hg. Your examination is notable for truncal instability when the child attempts to sit up. What is the next step in your workup? 

Case Conclusion

On rapid noncontrast head CT, the girl was found to have a brain mass. Neurosurgery and oncology were quickly consulted. The head of the patient’s bed was raised to 30°, and she was admitted to the pediatric intensive care unit for hourly neurological checks. She was given IV 3% hypertonic saline, IV levetiracetam, and IV corticosteroids per neurosurgery recommendations. She was eventually diagnosed with pilocytic astrocytoma. 

Click to review Pediatric Emergency Medicine Practice, Safe Use of Opioids

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Last Updated on July 24, 2023

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