Thinking laterally

Imagine for a moment...

You are a young doctor in a developing country. It's a Wednesday afternoon, just after lunch, as you wipe the sweat from your brow on an otherwise normal 40degree day with humidities above 90%.

Three weeks ago, you were trawling the wards of the local Australian tertiary hospital, checking on the octogenarians with COPD, the six-foot-five 19yo with bi-lateral spontaneous pneumothorax and now you are here.

A young, 12yo. boy presents with focal convulsions and right-sided weakness. You note his physical appearance to be short statured, low set ears, up-slanting palpebral fissures and suspect he has trisomy 21.

The differentials start to run through your head;

"what's his sensation like?"

"increased chance of stroke due to congenital cardiac disease"

"where does the DCML decussate again?"

"Was it PCA or MCA terminal branches that give a pure sensory thalamic stroke..."

"man i'm thirsty."

But what comes next will stand out for you as a young doctor forever...

read on:

https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-017-1258-7