Child Neurology: Pheochromocytoma Unveiled by Reversible Cerebral Vasoconstriction Syndrome in a Child With Neurofibromatosis Type 1
Notice bibliographique
Résumé
A 17-year-old right-handed boy of Korean descent developed sudden onset of palpitations with a general feeling of tremulousness and subsequent flushing.This was followed by a thunderclap headache described as if his entire head exploded and the worst pain of his life.This was accompanied by vertigo, nausea, photophobia, dyspnea, and right ocular pain with conjunctival erythema and binocular blurry vision.The latter symptoms improved after 15 minutes.Two days later, the patient sought medical attention due to improved but persistent occipital and right-sided headache.A head CT and CT angiogram were performed.His CT was unremarkable while his CT angiogram showed multivessel irregular narrowing without hemorrhage (figure ,A).He was transferred to our tertiary center for further evaluation and management.The patient reported a similar episode 5 months previously.While swimming, he had sudden onset of palpitations and a severe occipital headache accompanied by vertigo and binocular blurriness.This episode resolved with rest and acetaminophen.He endorsed other milder similar episodes of exercise-induced headache in the previous 6 months.The patient's review of systems was unremarkable, with no systemic symptoms of fever, weight loss, or rash.The patient's medical history revealed a congenital left lower leg deformity and multiple caféau-lait (CAL) spots.A prior head MRI in Korea had been normal, and the family was told that he did not have neurofibromatosis type 1 (NF-1).He has a long-standing history of weekly headache suspicious for migraine.His development and cognition were normal.Regarding family history, the patient's father (unavailable for examination) was suspected to have neurofibromas without CAL spots.On physical examination, the patient's manual blood pressure was 138/82 mm Hg.His head circumference was 57.5 cm (+1 SD).His mental status was normal.We confirmed multiple CAL spots with more than 10 larger than 1.5 cm.Axillary freckling and cutaneous neurofibromas were noted.He had convex bowing of his left lower extremity.His neurologic examination revealed a normal cranial nerve examination including normal funduscopy.His tone, deep tendon reflexes, strength, and coordination were normal.He had an area of decreased sensation (temperature and pinprick) on the dorsal aspect of his left foot.He had an unremarkable cardiovascular examination exempting hypertension.Considering the clinical diagnosis of NF-1 (made on examination), our differential diagnosis for the headache and abnormal neuroimaging included NF-1 vasculopathy, transient vascular spasms, or vasculitis.An urgent MRI with vessel imaging was ordered to rule out a stroke.The imaging confirmed multivessel arterial irregular narrowing without vessel wall enhancement
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».