(Pediatrics in Review. 2001;22:104-107. doi:10.1542/10.1542/pir.22-3-104)
© 2001 American Academy of Pediatrics
Click here for Visual Diagnosis: A Child Who Has a Nosebleed and High Blood Pressure Author Disclosures Data Supplement
Visual Diagnosis: A Child Who Has a Nosebleed and High Blood Pressure
Andrea Herman, MD*
*
Doernbecher Children’s Hospital, Oregon Health
Sciences University, Portland, OR.
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Presentation
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An 11-year-old boy is admitted to the pediatric intensive care
unit because of high blood pressure. Eight hours earlier, he suddenly
developed intermittent nosebleeding. His parents brought him to the
emergency department because they could not stop the bleeding over the
previous hour. On arrival, the patient’s blood pressure was
250/170 mm Hg. He denied headache, dizziness, or blurred vision.
The nosebleed was stabilized with pressure and packing. Because his
blood pressure improved minimally after three separate administrations
of intravenous labetolol, he was transferred to the intensive care unit
for further evaluation and therapy.
The patient’s medical history revealed a 6-month history of episodic
headaches, vomiting, and fatigue. Three months ago, these episodes
occurred weekly, prompting the patient to seek medical care. Findings
on physical examination were normal, including a systolic blood
pressure of 95 mm Hg. Results of laboratory evaluation, consisting
of complete blood cell count, urinalysis, serum glucose, thyroid
stimulating hormone, and computed tomography (CT) of the head (Fig. 1
),
were normal. Migraine headaches were
diagnosed, and the patient was treated with propranolol. After 2
weeks without symptomatic improvement, the boy’s parents discontinued
propranolol therapy.
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Figure 1. Normal CT scan of the head.
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Two weeks later, the patient developed blurred vision, returned to the
hospital, and was admitted for evaluation. His systolic blood pressures
ranged from 115 to 164 mm Hg and diastolic blood pressures
from 75 to 103 mm Hg. An ophthalmologist noted decreased
vision in the right eye as well as papilledema and stellate macular
changes on retinal examination. Magnetic resonance imaging (MRI) of the
head demonstrated patchy high-signal changes in the white
matter (Fig. 2
).
Cerebrospinal fluid evaluation
revealed an opening pressure of 27 mm H2O, a white
blood cell count of 2 cells/mcL, a red blood cell count of 7
cells/mcL, a normal . . . [Full Text of this Article]
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Click here for Visual Diagnosis: A Child Who Has a Nosebleed and High Blood Pressure Author Disclosures Data Supplement
Copyright © 2001 by the American Academy of Pediatrics.
