Management of Rare Case of Hemiplegya in Emergency Department

Abstract

Background: Although, loss of consciousness in children and adolescents is produced, in most cases, of neurally mediated hypotension whose clinical expression is vasovagal syncope, a rigorous differential diagnosis is required to eliminate the cardiac, neurological or psychiatric conditions that can cause syncope.

Case Report: An 8-year-old athlete with no significant personal history is brought with an ambulance in the emergency department (ED) for loss of consciousness, vomiting and seizures with sudden onset, without prodromal signs and symptoms while she was in the playground and jumped on an elastic trampoline. Computer tomography revealed a large area of ischemia associated with lack of opacifiation of the entire left middle cerebral artery, magnetic resonance imaging revealed multiple areas of ischemia in the cerebellum, pons and medulla also magnetic resonance angiography including time-of-flight (TOF) sequences showed absence of blood flow in the left middle cerebral artery. The surprise in this case was in echocardiography which revealed a giant left atrial myxoma, multilobulated, with transvalvular protrusion, without symptoms, even in the conditions in which, patient participated in training in a club of athletics, being subjected to intense and prolonged efforts. Subsequently, the patient was sent to intensive care for monitoring and treatment but, unfortunately, died a week after.

Conclusion: The case, presents all the ingredients for fatal evolution, namely: Ignoring or omitting the family history of atrial myxoma, absence of screening echocardiography, absence of symptoms and clinical signs of left atrial myxoma as well as sudden onset with major cardiac and cerebral complications occurring concurrently.