Jump to content

8 year old with hemiplegia


Recommended Posts

Open with vital signs, then general patient history, followed by history of current illness.

(Duh!)

vital signs all normal for age.

General patient history

Child is 8 years old. She is in mild distress, no major medical problems. No history of illness over past year. Pretty darn healthy. Had recent doctor visit for sports physical.

History of current illness - was sitting at home watching a little tv. She had a very stressful day at school as one of her friends was taken to the hospital for a seizure.

Link to comment
Share on other sites

Well, any issues wi her as a baby/young child. Any time spent NICU/PICU

Is it weakness or full paralysis. What about sensation. Any family history of clotting problems?

Last but not least any history of attention seeking behavior

Link to comment
Share on other sites

She is in mild distress,

Mild distress as in she's anxious, or something else?

Other Cincinnati stroke scale signs? Any aphasia? How long ago did it start/ did someone notice it?

Any recent trauma?

Any family hx of seizures? Was someone with her when symptoms started to get a good story of what preceded the symptoms (was it slow, affecting only one area first, or all at once, any seizure activity seen?)

Are symptoms changing currently/ getting better/ worse?

Link to comment
Share on other sites

Well, any issues wi her as a baby/young child. Any time spent NICU/PICU

Is it weakness or full paralysis. What about sensation. Any family history of clotting problems?

Last but not least any history of attention seeking behavior

No time spent in the NICU or PICU as a infant or child

Full sided weakness to right side.

No history of clotting problems

No attention seeking behaviour

Mild distress as in she's anxious, or something else?

Other Cincinnati stroke scale signs? Any aphasia? How long ago did it start/ did someone notice it?

Any recent trauma?

Any family hx of seizures? Was someone with her when symptoms started to get a good story of what preceded the symptoms (was it slow, affecting only one area first, or all at once, any seizure activity seen?)

Are symptoms changing currently/ getting better/ worse?

Anxious because this is not the first time she has experienced these symptoms but the first time her parents have seen them. She tells you that these symptoms have been going on for as long as she can remember. She does remember them happening as early as 4 years old.

Your partner is questioning the parents and your questions are focused on the child and she tells you that she has had these episodes several times prior to this, almost all the episodes occurred prior to her going to bed, but they have always resolved on her waking up.

Cincinnati stroke scale - only the hemiplegia is present and her mouth wont smile. She can talk fine.

No seizure activity, it starts with fingers tingling Per the child and progresses to full right side of the body.

Symptoms are not changing.

What do we find when we do a good cardiac exam?

Good pulses, strong radial.

monitor shows sinus tach at 130 - she's a little nervous. When she calms more down her rate drops to about 108

12 lead is unremarkable. Nothing out of the ordinary on this.

She does tell you that her previous episodes seem to be that they affect alternate sides of her body and it's not the entire side of her body she says.

Edited by Ruffems
Link to comment
Share on other sites

Sounds like some form of seizure dissorder but its weird that it would switch sides, do they only happen when there is an increased stress level or is there other causes/no causes?

You said this is the first time the parents have witnessed it but have they been told about it before? If so did they mention it to the child's dr?

Link to comment
Share on other sites

I was thinking Todd paralysis also, following absent or partial seizures. However, I don't think we can rule out something more dangerous such as TIA or bleed.

With her hx it sound like we don't know how long it normally takes the paralysis to clear up (since it happens before bed and then she wakes up fine) so we don't know if this length is "normal" for her or not.

Link to comment
Share on other sites

×
×
  • Create New...