Approach to a suspected brain tumor (pediatrics) Quiz: Ace Your Exams
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A previously healthy 9-year-old girl is brought to the emergency department by a parent for disorientation. According to the parent, the child woke up in the morning and did not recognize family members. The symptoms are associated with right-sided upper and lower extremity weakness over the past few days, which had been attributed to tiredness after a sports event. There has been no vomiting, headache, seizures, or fever. Family and developmental histories are non-contributory. Temperature is 37°C (98.6°F), pulse is 100/min, respirations are 20/min, blood pressure is 115/68 mmHg, and oxygen saturation is 98% on room air. On physical examination, the patient is disoriented to time, place, and person. Neurological exam reveals 3/5 strength with hyporeflexia in the right upper and lower extremities. Strength and tone are normal on the left side. Cardiopulmonary and abdominal exams are unremarkable. Blood glucose, electrolytes, and complete blood count are within normal limits. While additional laboratory studies are pending, the patient has a generalized tonic-clonic seizure and oxygen saturation drops to 80%. There is poor respiratory effort, and oxygenation does not improve with nasal cannula. Which of the following is the best next step in the management of this patient?
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