Welcome back friends to another installment of Diagnose This; the noodle scratching game that helps everyone out there learn about some common (as well as some quite rare) medical conditions and to help revise some core concepts to ace those exams!
Now, onto last week’s case!
If you would cast your mind back you will remember the patient with a number of quite worrying symptoms. The provisional diagnosis that is correct in this case is lateral medullary syndrome, also known as Wallenberg Syndrome (after Adolf Wallenberg, the man who first described the condition in 1895), caused by the occlusion of the left posterior inferior cerebellar artery. The way to tell is through the symptoms: ipsilateral facial and contralateral trunk and limb sensory/pain/temperature loss. The common symptom that is difficult to cure is chronic and violent hiccups, an unusual symptom to have but nonetheless a distressing one for any patient to have.
Hope you got it all right, let’s see what the next patient has!
A 3 year old male presents with a high fever for the past 3 days, and upon admission develops noisy breathing. He is completely up to date with his vaccinations. Diffuse cervical lymphadenopathy of approx. 2 cm in diameter are present, as are bilaterally large tonsils with exudate along the surface. Lymphocytosis is present, and a rapid strep test is negative.
What is the main condition that should be considered in this case? What is the recommended treatment? And finally, which of the mentioned symptoms is only found in a handful of conditions and helps clinch the diagnosis?
Find out next week on Diagnose This! Exclusive to bloodbonesandbodies.
The Royal Children’s Hospital was founded in 1870 and was originally called the ‘Melbourne Free Hospital For Sick Children’ and had only 6 inpatient beds. The hospital now has over 334 beds and sees over 77,000 kids in its ED alone every year!
Image: “The Royal Children’s Hospital, Melbourne” by Whatmov – Own work. Licensed under CC BY-SA 3.0 via Commons – https://commons.wikimedia.org/wiki/File:The_Royal_Children%27s_Hospital,_Melbourne.jpg#/media/File:The_Royal_Children%27s_Hospital,_Melbourne.jpg