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Boy With Upper Neck Pain and Generalized Weakness
IMAGES IN EMERGENCY MEDICINE Justine Stremick, MD, MPH&TM; Ryan Walsh, MD 0196-0644/$-see front matter Copyright © 2016 by the American College of Emergency Physicians. http://dx.doi.org/10.1016/j.annemergmed.2016.02.028
Figure. MRI of the brain showing left sided otomastoiditis (white arrow), subdural empyema (A), and adjacent cerebellar edema with left to right shift (B).
[Ann Emerg Med. 2016;68:519.] A 12-year-old boy with a recent history of sinusitis and acute otitis media presented to the emergency department with 3 weeks of upper neck pain and generalized weakness. He also reported headaches and occasional diplopia and vomited twice the day before presentation. The patient was afebrile, with normal vital signs. On examination, he was listless and found to have a left-sided ear effusion, left-sided total facial paralysis, left-sided hearing loss, mild left upper extremity weakness, and ataxia. Laboratory values were significant for an increased WBC count of 30.42 103/mL and a C-reactive protein level of 15.7 mg/L.
For the diagnosis and teaching points, see page 528. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com Volume 68, no. 4 : October 2016
Annals of Emergency Medicine 519
528 Annals of Emergency Medicine
Volume 68, no. 4 : October 2016
Figure. MRI of the brain showing left sided otomastoiditis (white arrow), subdural empyema (A), and adjacent cerebellar edema with left to right shift (B).
[Ann Emerg Med. 2016;68:519.] A 12-year-old boy with a recent history of sinusitis and acute otitis media presented to the emergency department with 3 weeks of upper neck pain and generalized weakness. He also reported headaches and occasional diplopia and vomited twice the day before presentation. The patient was afebrile, with normal vital signs. On examination, he was listless and found to have a left-sided ear effusion, left-sided total facial paralysis, left-sided hearing loss, mild left upper extremity weakness, and ataxia. Laboratory values were significant for an increased WBC count of 30.42 103/mL and a C-reactive protein level of 15.7 mg/L.
For the diagnosis and teaching points, see page 528. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com Volume 68, no. 4 : October 2016
Annals of Emergency Medicine 519
528 Annals of Emergency Medicine
Volume 68, no. 4 : October 2016