PEMPix is the American Academy of Pediatrics Section on Emergency Medicine’s annual visual diagnosis competition. This year, in addition to the 10 finalists Maneesha Agarwal will be presenting at the National Conference and Exhibition we will be sharing four cases online in advance of the conference. This is the first of the four cases.
This case was submitted by
Dr. Andrea De Jesús Martínez
Chief PEM Fellow at Baylor College of Medicine | Texas Children’s Hospital
Instagram: @bcm_pemfellows
Co-author: Benjamin Silva, MD, MPH
The Case
A 4-year-old male with no significant past medical history presents with headache and vomiting. About 2 weeks prior, he had an ED evaluation after a 2-3 foot fall onto a carpeted floor with subsequent vomiting. At that visit, his physical exam was normal. He had a CT scan (depicted below) that was reviewed by the neurosurgery team, and he was cleared for discharge home.
During this ED visit, the family notes that the child has had 1 week of vomiting whenever he eats. They also note that he has been waking up in the early morning with a headache that is self-resolving and occasional associated vomiting. The patient has had improving activity and energy since his fall and initial ED evaluation 2 weeks prior.
During this second ED visit, his physical exam including vital signs and mental status remains normal. His neurologic exam reveals an alert child with GCS of 15. No facial asymmetry. Moves all extremities equally against gravity. Intact sensation to light touch bilaterally. No CN II-XII deficits noted. A second CT scan is obtained with relevant cuts depicted below.
