Case 16-2005 - A Nine-Year-Old Girl with Headaches and Hypertension

doi:10.1056/NEJMcpc059011

Volume 352:2223-2231		May 26, 2005		Number 21

Case 16-2005 — A Nine-Year-Old Girl with Headaches and Hypertension

Daniel S. Kohane, M.D., Ph.D., Julie R. Ingelfinger, M.D., Katherine Nimkin, M.D., and Chin-Lee Wu, M.D., Ph.D.

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Presentation of Case

A nine-year-old girl was admitted to this hospital because ofheadaches, enuresis, recent visual changes, and vomiting.

Intermittent frontal headaches began 18 months before admission,occurring most often during physical activity, but occasionallyin the early morning, accompanied by nausea, but without vomiting,visual changes, or facial flushing. The child had been squinting,and she said she had been having difficulty reading; one monthbefore admission, the results of an eye examination were reportedlynormal.

Nocturnal enuresis began eight months before admission and didnot respond to fluid restriction and voiding before bedtime.The patient was evaluated by an urologist . . . [Full Text of this Article]

Differential Diagnosis

Management of Hypertensive Emergencies

Identifying the Problem

Treating the Problem

Perioperative Management of Pheochromocytoma

Clinical Diagnosis

Pathological Discussion

Anatomical Diagnosis

Source Information

From the Departments of Pediatric Critical Care (D.S.K.), Pediatric Nephrology (J.R.I.), Radiology (K.N.), and Pathology (C.-L.W.), Massachusetts General Hospital; and the Departments of Pediatrics (D.S.K., J.R.I.), Radiology (K.N.), and Pathology (C.-L.W.), Harvard Medical School.