This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page.

We invite readers to contribute case presentations and discussions.

A 9-year-old Native American boy is brought to the emergency department because of bizarre behaviors. He was acting normally at dinner,but at 10:00 pm he was found wandering, picking at things in the air,mumbling incomprehensibly, and unable to follow commands.

On physical examination, the child is unable to engage in meaningful conversation and cannot give any reliable information. His oral temperature is 37.6°C(99.6°F), pulse is 129 beats/min,...

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