22nd Annual Pain Medicine Meeting 2023

INTRODUCTION

•Headache is among the most common neurological disorders with similar differential diagnosis in adults as well as in pediatric population, with migraines being the most common primary headache encountered.

•The recognition and differentiating of the small number of patients with life threatening headaches from the ones with benign primary headaches is fundamental

•We present a case in which migraine was part of the differential diagnosis, but the clinical evolution showed a more severe entity.

MATERIALS AND METHODS

As this case report is devoid of patient identifiable information, it is exempt form IRB review requirements as per Cook County Health, Stroger Hospital’s policy. The informed consent was obtained from patient’s parents for submission of this case report.

CASE PRESENTATION

A 6-year-old male with no PMH and no history of autoimmune. Presented with one week of frontal headache associated with eye pain, photophobia, and fatigue.

•Tested positive for strep throat infection and was treated with Penicillin G.

•Symptoms has progressed in 10 days to unsteady gait, dysarthria, and diplopia.

•Afebrile, HDS, CBC with elevated WBC 29, CRP 5.4, and ESR 59

•Initial MRI was negative, LP with minimal leukocytosis 90 with normal protein, and glucose. Viral panel, Blood and CSF cultures, and PCR were negative.

•2nd MRI was done in 4 days and showed nonspecific findings consistent with cerebellitis and subtle leptomeningeal enhancement. While receiving IV antibiotics for suspected meningitis neurological deficit has progressed.

•3rd MRI brain/spine showed extensive non-enchancing T2 hyperintensity throughout right dentate nucleus, bilateral superior cerebellar peduncles/dorsolateral midbrain, ventral medulla, thalamus, and corpus collosum. After ruling out other potential causes, the diagnosis of acute demyelinating encephalomyelitis (ADEM) was suspected. The patient responded to steroids with no residual deficits.

DISCUSSION

ADEM is a demyelinating disease of the central nervous system, characterized with headache, non-specific symptoms and acute or subacute encephalopathy with polyfocal neurological deficits.

ADEM is consider after excluding other causes of multifocal neurologic deficits.

MRI with demyelinating lesions will further support the diagnosis.

Often misdiagnosed patients generally appear less ill and do not have neurologic deficits, leading to misdiagnosis.

22nd Annual Pain Medicine Meeting 2023

UNEXPLAINED HEADACHE IN A PEDIATRIC PATIENT

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