Case 5: Headache, Vomiting, and Elevated Blood Pressure while Voiding in an 8-year-old Girl

Abstract

1. Ara Healey, MD*,† 2. Liam Fardy, MD*,‡ 3. Kevin Chan, MD, MPH*,† 1. *Department of Pediatrics, Memorial University of Newfoundland Faculty of Medicine, St John's, Newfoundland and Labrador, Canada 2. †Children and Women's Health Program, Eastern Health, St John's, Newfoundland and Labrador, Canada 3. ‡Children’s Health, Central Health, Gander, Newfoundland and Labrador, Canada An 8-year-old girl from South Sudan presents to the emergency department with a history of severe headache and vomiting with urination. She describes the headache as being present “all over” her head and rates the pain “15/10.” There is no history of morning or positional headache. She has had a history of vomiting with urination and defecation since she was 1 year old. From 1 to 6 years of age, the vomiting occurred sporadically, but during the 2 years before the emergency department visit, vomiting was occurring 4 to 5 times daily with voiding and defecation. Initial vital signs reveal a heart rate of 114 beats/min, a respiratory rate of 24 breaths/min, a temperature of 97.0°F (36.1°C), and blood pressure (BP) of 122/88 mm Hg. Funduscopic examination results are normal. Results of cardiovascular, respiratory, abdominal, and central nervous system examinations are normal. In the emergency department, we observe the child screaming with a headache and vomiting after 3 separate voids. Her BP increases to 143/94 mm Hg during these episodes. Between voids, she does not complain of headache and does not vomit. Her headache is treated with intravenous morphine. After treatment with morphine, the BP returns to 120/84 mm Hg. We provide no further …