Case 5: Clinical DDx

Clinical History

HPI: 12 yo boy presents with chronic intermittant headaches, nausea and vomiting for 1 year. He now presents with difficulty walking over the past few days.

Questions

1. What is your clinical differential diagnosis?

• In this 12 year child, it is important to consider primary gastrointestinal disorders first. However, persistent nausea and vomiting without a GI source should illicit alternative etiologies. Patients with increased intracranial pressure can present with nausea and vomiting. Other focal neurologic symptoms such as ataxia or weakness may help to localize the abnormality to the CNS.

2. What scan would you order next?

Answer