Case 1: Delayed Diagnosis in a 13-year-old with Persistent Neurologic Symptoms after a Carnival Ride.

Abstract

1. Elizabeth J. Thompson, MD* 2. Benjamin Wildman-Tobriner, MD† 3. Victoria Parente, MD, MPH* 1. *Department of Pediatrics, 2. †Department of Radiology, Duke University Health System, Durham, NC For some of us, summer offers time to get rejuvenated and refreshed so we can return with positive energy as we get back into the “flow” of patient care activities. The notion of flow was popularized a decade ago by Mihaly Csikszentmihalyi in the bestseller Flow: The Psychology of Optimal Experience . Satisfaction with daily experiences was said to best result when we mindfully engage in a flowing state of consciousness that provides creativity and enjoyment. Similarly, physical health is impaired when organ systems are hindered from allowing body fluids to flow normally. This month’s Index of Suspicion cases include examples of altered blood and intestinal flow. Enjoy working through interesting diagnostic thought processes. Philip R. Fischer, MD Associate Editor, Index of Suspicion A previously healthy 13-year-old girl presented to her local emergency department with headache, word-finding difficulty, and transient vision changes after a carnival ride. Results of a noncontrast head computed tomographic (CT) scan were normal, and she was discharged from the local emergency department. Over the next 2 weeks her headache and intermittent word-finding difficulty persisted. She also developed paresthesia of the right hemibody and had trouble completing schoolwork. These symptoms prompted self-referral to a neurologist, who performed an electroencephalogram that was significant for left-sided slowing. The neurologist referred her to the hospital for further evaluation. On arrival at our hospital her vital signs are normal and she is not experiencing neurologic symptoms. Her physical examination reveals a 2/6 systolic ejection …