Clinical Reasoning: A 12-year-old girl with headache and change in mental status

Abstract

Section 1A 12-year-old girl presented to the emergency department with headaches for 1 week in the setting of a 20-pound weight gain over the last year. Headaches were described as severe, throbbing, constant, and occipital, with photophobia, nausea, and vomiting. Pain was worse with standing. Neurologic examinationThe patient's visual afferent examination was unremarkable. Her efferent examination was notable for a −1 right abduction deficit and a small angle esotropia. Her ophthalmoscopic examination showed bilateral papilledema. Her visual fields showed scattered shallow defects in the right eye and a deep superior hemifield defect in the left eye that crossed the vertical midline. Her body mass index was 35 kg/m 2 . The remainder of her general medical examination was normal and her neurologic examination was nonfocal.