Clinical Reasoning: A 15-month-old boy with progressive lethargy and spasticity

A previously healthy and developmentally normal 15-month-old boy presented to the emergency department with 5 days of worsening altered mental status in the setting of an upper respiratory infection. He initially developed cough, rhinorrhea, and irritability without fever, vomiting, or diarrhea. His mental status at home had slowly declined, with increased sleepiness and progressively decreased activity. At the time of presentation, he had stopped playing, walking, sitting, or drinking. On his initial examination, he was breathing comfortably on room air and was afebrile with normal vital signs. He did not respond to stimuli and had developed intermittent rhythmic shaking of his arms, concerning for seizures. He had no visual tracking and minimal pupil reactivity. He had diffuse hypertonia with bilateral flexion of the upper extremities and extension of the lower extremities without spontaneous movement, minimal withdrawal to noxious stimuli, diffuse hyperreflexia, and several beats of left Achilles tendon clonus.
Source: Neurology - Category: Neurology Authors: Tags: All Infections, All Clinical Neurology, Parasitic infections, Retina, All Pediatric RESIDENT AND FELLOW SECTION Source Type: research