Case 4: Weakness and Headaches in a 14-year-old Boy

Alyssa White; Xibei Liu; Samrat U. Das

doi:10.1542/pir.2016-0164

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Alyssa White, MD*
Xibei Liu, MD*
Samrat U. Das, MD^†

^*University of Nevada School of Medicine, Las Vegas, NV
^†Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, NV

AUTHOR DISCLOSURE
Drs White, Liu, and Das have disclosed no financial relationships relevant to this article. Dr White’s currect affiliation is Pediatrics Residency Program, University of Las Vegas School of Medicine, Las Vegas, NV. Dr Liu’s current affiliation is Department of Internal Medicine, University of Arizona College of Medicine-Tucson, AZ. Dr. Das’s current affiliation is Pediatric Hospitalist, Duke University School of Medicine, Durham, NC. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

A 14-year-old boy presents to the hospital with headache and weakness for the third time in 3 months. One day before hospital admission the patient developed a severe headache that resolved with sumatriptan use. Hours before arriving at the hospital he played basketball for half an hour outside, but on returning home he noticed a worsening throbbing right-sided frontal headache without radiation. Within a few minutes the patient developed progressively increasing weakness in all 4 extremities, which prompted him to lie down. His previous presenting symptoms had included fever, headache, dizziness, blurry vision, stumbling gait, and stiffness, muscle tightness, and a tingling sensation in all 4 extremities. At previous presentations, acute disseminated encephalomyelitis (ADEM) and migraines were suspected, and the patient was started on high-dose (1 g per 24 hours for 5 days) intravenous methylprednisolone, with a prednisone taper, to which he responded very well and symptoms (headaches, dizziness, weakness, ataxia) resolved.

The child was in good health until 3 months ago. His medical history is significant for intermittent asthma, triggered by weather changes, which is well controlled …