Walking the “Wait and See” Tightrope: A Diagnostic Dilemma Balancing Act :

When are muscle jerks or posturing in an infant a matter of concern? I think that if these episodes are intermittent and resolve spontaneously, most of us would reassure the parents and say, “let’s keep an eye on it.” Or we might consider gastroesophageal reflux disease as a possibility and begin pharmacological or non-pharmacological treatment.

This month’s Diagnostic Dilemmas and Clinical Reasoning case from Beinvogl et al. (peds.2015-1896) is one in which the initial presentation is similar to cases that you and I probably see on a weekly basis. At what point, however, does our thinking change from “wait and see” to “something isn’t right,” and you embark on a workup?

This month’s case is a fascinating one, and definitely one that will exercise your knowledge base as you generate a differential diagnosis in your mind and consider what your workup would be at each step. This case will also remind you that knowing how to localize a potential neurologic lesion can be helpful in narrowing down your diagnostic possibilities.