ABSTRACT
Case Presentation ................................................................................................... 177 Differential Diagnosis ............................................................................................ 178 Diagnostic Approach ............................................................................................. 179 Treatment ............................................................................................................... 179 Long-Term Outcome .............................................................................................. 179 Neurobiology/Pathophysiology of Disease ............................................................ 180 Clinical Pearls ........................................................................................................ 180 Suggested Reading ................................................................................................. 180
The patient is a right-handed 5-year-old girl without a signicant past medical history and with normal development. She was urgently seen in the emergency department for altered mental status. Her parents brought her because of unusual behaviors one morning: repeatedly asking the same question and preparing for school on a Sunday. She woke up that morning complaining of stomach upset and vomited three times. Her mother thought she looked pale and her eyes appeared dilated. After the unusual behavior began, the parents brought her to the hospital. The parents denied fever, ill contacts, or access to medications or household chemicals. Her development was normal, and she had no risk factors for epilepsy. Her family history was unremarkable. On examination, she was mildly tachycardic and appeared pale, but was not ill-appearing or diaphoretic. She answered questions with inappropriate responses and did not cooperate fully with the exam. Her pupils were dilated but reactive.
