A 2-year-old male presented to the emergency department with a headache and vomiting episode together with muscle weakness and hypotonia after refusal to take the medication, with no loss of consciousness, lasting for seconds, and a good recovery.
He did not present any signs of neurological focality or reported medication intake.
Afebril.
You do not have other associated symptoms.
Physical location: temperature: 36 oC; weight: 13.6 kg; blood pressure: 114/60 mm/Hg; heart rate: 91 bpm; transcutaneous oxygen: 100% with environmental air saturation with good hydration; mucocutaneous oxygen: 100%.
Rest of neurological examination and equipment: normal, except for low reactivity to stimuli.
Complementary tests: leukocytes: 14,300 (segmented: 69%, lymphocytes: 23%, monocytes: 6% and eosinophils: 2%); hemoglobin: 10.9 g/dl; mean corpuscular volume: 73ml; platelets: 4
Gas: ph: 7.37; pCO2: 44; bicarbonate: 26.
Serum glucose: 90 mg/dl; creatinine: 0.4 mg/dl; Na+: 139 mEq/l, K+ mEq/l.
C-reactive protein: 0.4 mg/l; oxalacetic glutamic transaminase: 33; pyruvic glutamic transaminase: 24.
Cranial computed tomography (CT) showed no abnormalities.
Urine toxicology: negative.
Lumbar puncture: 0 cells.
When observing the patient in the emergency department, the patient developed 4 vomiting and a tendency to sleep.
An abdominal ultrasound is performed in which an invagination-ileal is observed and the ileo-ileal surgery service of reference hospital, where the ultrasound is repeated.
There are no signs of invagination, but there are several adenopathies affecting the mesentery.
The patient was discharged without complications.
