A 14-year-old female presented to our hospital for a second opinion regarding a recent diagnosis of Graves' disease and a mediastinal mass. Four months prior to presentation, the patient developed difficulty with concentration. Historically she had been an A/B student; however, her school performance worsened suddenly, and she almost failed the eighth grade. One month later, she began complaining of increased sweating, diarrhea, difficulty with balance, jitteriness, and difficulty sitting still. During the previous 2 months, she had an increased appetite along with a 10-lb weight gain, increased hair loss, fatigue, and dry skin. Two weeks prior to her presentation, her mother noted that she had a "large neck mass." At that time, the patient complained of dysphagia and tenderness of the anterior neck on palpation, but she had no respiratory difficulties. In addition, she had no symptoms of fever or night sweats.
A 9-year-old boy with a past medical history of asthma was admitted from the emergency department (ED) for evaluation of a rash, polyarthralgia, and hyperglycemia noted at the referring hospital. The rash was reported as purpuric "bumps," which started 3 days prior to presentation. The rash had initially presented on the lower extremities and had progressively worsened as well as spread to both upper extremities. He also complained of pain in his right knee and lower extremity swelling with limited flexion bilaterally. There was no history of polyphagia, polydipsia, nausea, vomiting, diarrhea, abdominal pain, headache, or fever. The patient mentioned that he had lost approximately 10 lbs during the past year, but he had been trying to lose weight.
A 6-year-old girl was referred to pediatric neurology because of concerns about her behavior. Her mother had noticed episodes in which the girl would wave her hand in front of her face and lose awareness of her surroundings several times per day. These episodes usually occurred when she was outdoors and had caused the child to walk into objects and stop in traffic. The patient otherwise had no neurological deficits or cognitive impairment, and there was no family history of neuropsychiatric disorders. Although the patient was aware of her behavior, she could not explain why she performed these hand-waving motions. A neurological workup revealed that these behaviors were not complex stereotypies but rather a rare and unusual disorder. This case highlights the role of neurology in assessing complex motor behaviors and offers insight into when a practicing pediatrician should consider a neurological workup for complex stereotypies.
[
Pediatr Ann
. 2023;52(8):e309–e312.]
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.