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Case 29
A 9-month old previously healthy baby girl is brought to the emergency room obtunded. Her mother
reports that the baby was fine that morning when she left her with her boyfriend to go to work. The
boyfriend reports that the baby began vomiting that afternoon, and then became too lethargic to feed.
On examination the infant is afebrile with a pulse of 70, her anterior fontanelle is bulging, and she is
unresponsive with her eyes deviated downwards.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why these
are less likely.
3) What additional information (history, exam, laboratory or other studies) would you like to obtain?
What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you manage this patient? How would you
monitor her condition and its treatment? What is the prognosis?
Case 29
A 9-month old previously healthy baby girl is brought to the emergency room obtunded. Her mother
reports that the baby was fine that morning when she left her with her boyfriend to go to work. The
boyfriend reports that the baby began vomiting that afternoon, and then became too lethargic to feed.
On examination the infant is afebrile with a pulse of 70, her anterior fontanelle is bulging, and she is
unresponsive with her eyes deviated downwards.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why these
are less likely.
3) What additional information (history, exam, laboratory or other studies) would you like to obtain?
What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you manage this patient? How would you
monitor her condition and its treatment? What is the prognosis?