Management of Rare Case of Hemiplegya in Emergency Department

Background: While the most common cause of loss of consciousness in children and adolescents is neurally induced hypotension, which manifests clinically as vasovagal syncope, a thorough differential diagnosis is needed to rule out cardiac, neurological, or psychiatric causes of syncope.

Case Report: An 8-year-old athlete with no significant personal background is transported to the emergency room (ED) by ambulance after experiencing loss of consciousness, vomiting, and seizures of sudden onset and no prodromal signs and symptoms while playing on an elastic trampoline in the playground. Magnetic resonance imaging indicated various areas of ischemia in the cerebellum, pons, and medulla, as well as magnetic resonance angiography including time-of-flight (TOF) sequences, which revealed the absence of blood flow in the left middle cerebral artery. Except in the circumstances in which the patient engaged in competition in a club of athletics, being subjected to intensive and prolonged efforts, echocardiography showed a giant left atrial myxoma, multilobulated, with transvalvular protrusion, without symptoms. The patient was then transferred to intensive care for observation and treatment, but sadly, he died a week later.

Conclusion: The case contains all of the elements for a tragic outcome, including ignoring or omitting a family history of atrial myxoma, the lack of screening echocardiography, the absence of symptoms and clinical signs of left atrial myxoma, and the abrupt occurrence of severe cardiac and cerebral complications.

Author (s) Details

Luciana Teodora Rotaru
Department of Emergency Medicine and First Aid, University of Medicine and Pharmacy of Craiova, 4 Petru Rareș Street, Zip Code 200349, Craiova, Dolj County, Romania.

Mircea-Cătălin Forțofoiu
Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 4 Petru Rareș Street, Zip Code 200349, Craiova, Dolj County, Romania.

Octavian Istrătoaie
Department of Cardiology, University of Medicine and Pharmacy of Craiova, 4 Petru Rareș Street, Zip Code 200349, Craiova, Dolj County, Romania.

Cristian Constantin
Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, 4 Petru Rareș Street, Zip Code 200349, Craiova, Dolj County, Romania.

Dana Maria Albulescu
Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, 4 Petru Rareș Street,  Zip Code 200349, Craiova, Dolj County, Romania.

Maria Forțofoiu
Department of Emergency Medicine and First Aid, University of Medicine and Pharmacy of Craiova, 4 Petru Rareș Street, Zip Code 200349, Craiova, Dolj County, Romania.

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