A 4-year-old girl from rural North Carolina presents to an outpatient clinic after 2 successive emergency department (ED) evaluations for sudden-onset difficulty walking. Symptoms began the morning of her initial ED presentation when her parents noticed stumbling and gait incoordination. Her symptoms progressed rapidly to overt lower extremity weakness, culminating in an inability to stand. She was walking normally the night previously. The patient has a history of epilepsy. Her first seizure occurred at 2 years old. She had been treated in the past with carbamazepine. She has been without seizure for 1 year and weaned from antiepileptic medications 6 months ago after normal findings on video electroencephalography and brain magnetic resonance imaging. There is no recent illness reported. With her current presentation, there is no report of fever, headache, neck pain, vision complaint or tearing, mentation change, sensory alteration, dysphagia, drooling, cough, wheezing, rhinorrhea, dyspnea, diarrhea, emesis, or rash....
Case 1: Weakness and Gait Instability in a 4-year-old Girl
Drs Olewnik and MacHue have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
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LCDR Adam J. Olewnik, LT Daniel MacHue; Case 1: Weakness and Gait Instability in a 4-year-old Girl. Pediatr Rev July 2020; 41 (7): 357–360. https://doi.org/10.1542/pir.2018-0244
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