Suspected Sudden Visual Loss In A 2-Year-Old Girl

Hani Alsaedi, MD*2. Katsuaki Kojima, MD, PhD*3. Ajovi Scott-Emuakpor, MD, PhD* 1. *Departments of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MIThis case concerns a 28-month-old girl with a history of polycythemia, bronchopulmonary dysplasia, and pulmonary hypertension who was being treated with sildenafil. She is brought to a community hospital emergency department by her parents for evaluation of a suspected sudden-onset right-sided visual loss. On the day of admission, the patient’s parents notice that she is clumsy, as evidenced by reaching out several inches off to the left of her target. Additionally, she walks into the infant gate instead of through it. She has no seizurelike activity, weakness, or facial drooping. She has several episodes of “explosive” diarrhea. This infant is the product of a pregnancy that was complicated by premature labor, leading to a premature delivery at 24 weeksu0027 gestation. She consequently spent several weeks in the NICU.At initial presentation, she is afebrile with a heart rate of 139 beats/min, a respiratory rate of 56 breaths/min, blood pressure of 100/67 mm Hg, and oxygen saturation greater than 95% in room air. Physical examination reveals a well-nourished, toxic-appearing girl. Her pupils are equal, round, and …