Monday, February 25, 2008

Judging clinically: A case with prolong vomiting, bulging fontanelle and unconsciousness


The boy was laying in the bed unconscious when I first saw the patient. He is a two year old boy with history of vomiting over 2 months and impaired consciousness for 3 days.
The vomiting was mainly in the early morning.
He was seen by his local physician and more than one pediatrician over the weeks.

On admission his GCS score was 8/15, he has braycardia, mild hypertension and bulging anterior fontanelle and mild papilloeema.

His CSF study was normal. MP was negative. US of the brain shows ventricular dilatations. CT scan shows homogeneous opacity in the cerebellum extending into the 4th ventricle and obstructing the CSF pathway causing hydrocephalus and the mass is labelleled as medulloblastoma

So, the case diagnosed as a case Medulloblastom of the Brain and referred to the Neurosurgeon for further management.

There was clue for the brain tumor in this patient- the vomiting persisting over days an dmostly in the morning and afebrile state of the child go in favour of brain tumour. The child should have been evaluated earlier by the CT scan to explore the possibility of brain tumour and the condition could have been diagnosed earlier.




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