Diencephalic syndrome is a rare clinical entity, traditionally encompassing severe failure to thrive, nystagmus, and hyperkinesis, secondary to an intracranial neoplasm that is classically located in the hypothalamic region and its vicinity. However, the presenting features can be variable, often resulting in delayed diagnosis, which may worsen prognosis. This case report describes the atypical presentation of a posterior fossa tumor with features reminiscent of diencephalic syndrome that have not previously been reported in the literature. We report a 21-month-old girl with a cervicomedullary brainstem astrocytoma, who presented with isolated gross motor developmental delay, decreased growth velocity, and stridor. The neurologic signs frequently reported in patients with diencephalic syndrome were absent; however, severe failure to thrive was present. This case broadens the etiologic differential diagnosis of diencephalic syndrome in addition to the traditional hypothalamic region tumor location. This case urges physicians to consider central neurologic processes in the differential diagnosis of children with refractory failure to thrive with or without classical features of diencephalic syndrome, in whom etiology is not identified by routine investigations, given its importance in determining prognosis and management. While failure to thrive (FTT) is a common clinical entity, diencephalic syndrome (DS) is a rare but lifethreatening cause. Russell 1 first described DS in 1951, based on a series of 5 children with hypothalamic neoplasms. Associated signs included profound emaciation, maintained linear growth, locomotor hyperactivity, euphoria, skin pallor, hypotension, and hypoglycemia.1 Other case series have reported nystagmus, visual field defects, headache, and emesis. 2 We report a DS-like presentation of a posterior fossa tumor in a 21-month-old girl, in whom linear growth was not maintained, isolated gross motor delay was present, and significant respiratory symptoms, including chronic cough and stridor, developed.CASE PRESENTATION The patient was born at 36 weeks gestation with no complications. Birthweight was 2.04 kilograms (3rd percentile), length was 46 centimeters (15th-50th percentile), and head circumference was not documented. She was breast and formula fed until 6 months of age, then transitioned to solids, at which point her weight was 5.4 kilograms (,3rd percentile). During this time, she developed recurrent vomiting with minimal response to antireflux medications. She also developed a chronic cough. Her weight gain plateaued after 6 months of age. She was referred to the FTT clinic at 11 months with a weight of 5.95 kilograms (,3rd percentile), height of 68 centimeters (3rd-15th percentile), and head circumference of 44 centimeters (15th-50th percentile). Around 17 months, she developed inspiratory stridor while sleeping. Increasing caloric intake was unsuccessful, and nasogastric (NG) feeds were initiated at 18 months. Despite NG insertion, she continued to experience daily vomiting....
Background. Fever is common in pediatric patients. Often, parents rely solely on palpation when assessing their child’s fever. The objective of the current study was to determine the accuracy of parents in detecting their child’s fever by palpation. Methods. A prospective cross-sectional study was conducted at the emergency department (ED) of a tertiary pediatric hospital. Infants and children, 0–4 years of age, presenting to the ED with both parents were included. Parents were separately asked if their child had a fever and, if so, were asked to assess the temperature by palpation. A nurse obtained the rectal temperature. The primary outcome measure was the accuracy of fathers and mothers in detecting fever. Results. A total of 170 children with their parents were enrolled. The mean ages of the children, mothers, and fathers were 18.9 (SD 0.8) months, 31.1 (SD 6.4) years, and 33.7 (SD 6.9) years, respectively. No statistically significant difference was found between mothers and fathers in the ability to assess fever by palpation (OR 0.65, 95% CI 0.39,−1.08). Sensitivities for detecting fever by palpation for mothers and father were 86.4% and 88.2%, respectively (specificity among mothers: 54.2% and specificity among fathers: 43.1%). The overall negative and positive predictive values were 65.9% (95% CI 55%–75.7%) and 75.7% (95% CI 69.9%–80.8%), respectively. Conclusions. Mothers and fathers do not differ in their ability to accurately assess their child’s fever by palpation. The low positive and negative predictive values indicate that if temperature was not measured, physicians cannot rely on parents’ reports.
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