Are you sure NEURO-kay?

Author: Rebecca Humphreys, Vikram Baicher / Editor: Nick Tilbury / Codes: / Published: 28/02/2023

Peter is 3 years old. His mum has brought him to the Emergency Department (ED) because for the last 6 days he has spent most of his time on the sofa, always lying on his left side. At times mum has had to carry him to the toilet because he doesnt want to move himself. Mum says hes just so still.

He hasnt been complaining of any pain or headache but has been vomiting over the past few days. Mum tells you his vomit has been normal in colour and he hasnt had any diarrhoea. He has also been reluctant to eat or drink.

Peter is normally fit and well though he did have an attendance with a fever 6 weeks previously. A source for his fever was not identified and he was discharged after 2 days of intravenous antibiotics. Blood cultures showed no growth.

His observations are as follows:

  • Heart rate 127
  • Respiratory rate 22
  • Temperature 36.7
  • Sp02 98% in room air
  • Blood pressure 101/58
  • GCS 15/15
  • PEWS 3

On examination he is lying on his left side and facing the wall. When you talk to him, he responds. He briefly moans but allows you to auscultate his chest and feel his abdomen, which are both normal.

You note he has brisk reflexes in his upper and lower limbs but there is no weakness. There is no pain when you move his arms or legs and no pain when you palpate his spine. You cant find any evidence of fractures or injuries and there is no erythema or warmth to indicate evidence of infection.

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