A 10-year-old African American boy presents to the emergency department with 24-hour history of throbbing headaches, dizziness, blurry vision, nausea, and difficulty with arousal this morning. He has had no trauma or emesis. Three weeks earlier, he had undergone surgical correction of a leg-length discrepancy of the left tibia and fibula and the application of the Ilizarov external fixation device that required daily lengthening by 1 mm. There were no complications and he was discharged home on postoperative day 3. Past medical history and family history for hypertension are negative.

At presentation, the boy's blood pressure is 190/106 mm Hg; he had normal readings throughout his hospital stay during and after surgery. His heart rate is 88 beats per minute, respiratory rate 20 breaths per minute, and oxygen saturation on room air 100%. He is afebrile and is not obese. On funduscopic examination, he has bilateral papilledema. His cardiac and...

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