Index of SuspicionCase 1: Prolonged Leg Pain and Restricted Hip Movements in a Teenage BoyCase 2: Headaches, Hypertension, and Ear Abnormalities in a Teenage GirlCase 3: Sudden Increase in Intracranial Pressure in a 15-month-old Girl Who Has Hydrocephalus

Case 1 Presentation

A 14-year-old boy comes to the adolescent clinic with a report of right leg pain for the past 2 years. The pain has increased drastically over the past 6 months to the point that he is unable to play sports, particularly football. Other than mild asthma and allergic rhinitis, he is in good health.

The patient, who moved to this area 4 years ago, has been seen in this clinic three times previously for management of asthma and for a routine health assessment 2 years ago. At those visits, he did not report hip pain or any limitation of activities. His past medical records are unavailable.

On physical examination, the patient is alert and pleasant and has height and weight at the 25th percentile. His right hip has flexion to approximately 90 degrees, internal rotation to less than 10 degrees, and external rotation to 25 degrees, all with pain at the extremes of movement. His left hip has flexion to 125 degrees, internal rotation to 15 degrees, and external rotation to 40 degrees, with no pain at the extremes of motion. When he is standing, his leg length is symmetrical. He has an antalgic gait on the right. His muscle strength and sensation, as well as his distal pulses, are normal. An imaging study confirms the diagnosis.

Case 2 Presentation

A 15-year-old girl presents to the clinic with episodic headaches occurring two to three times per week for the last 6 months. The headaches do not awaken her from sleep and are not associated with nausea, vomiting, or visual auras. She denies exercise intolerance, syncope, hematuria, and skin, …