ABSTRACT
Case Presentation ................................................................................................... 169 Differential Diagnosis ............................................................................................ 170 Diagnostic Approach ............................................................................................. 170 Treatment Strategy ................................................................................................. 174 Long-Term Outcome .............................................................................................. 175 Pathophysiology/Neurobiology .............................................................................. 175 Clinical Pearls ........................................................................................................ 175 Suggested Reading ................................................................................................. 176
Harriet’s family had become concerned about her. At 7 years she had been an honor role second grader, yet recently her grades were slipping. Her family had also begun to receive notes sent home from her teachers, as she was no longer attentive during class. Harriet grew increasingly cranky and unhappy. She was at a loss to explain her deteriorating school performance. It was not until one evening at the dinner table, when Harriet was telling a story, that her parents noticed that, when she paused, she had slight ptosis with slight rhythmic blinking and mouthing movements that did not abate when they called her by her name. This unresponsiveness lasted about 20 seconds, after which Harriet had no recollection of her parent’s alerting efforts.
