Interesting Peds EM Case

[GoBuckeyes913]

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10yo white male with no PMH presents via EMS with new onset of grand mal seizure, witnessed by parents. Fell out of his chair at dinner, lasted 2-3 minutes, episode of emesis afterwards, +urinary incontinence. ROS negative for everything under the sun. Now complaining of 10/10 frontal headache. Initial GCS of 15.

Vitals: BP 86/52, everything else normal (including fingerstick gluc).

Physical exam: everything unremarkable.

CT head: 2cm right sided hyperdense lesion at the globus pallidus, initially determined by radiology to be either 1) bleed or 2) calcification. They're not quite sure, and call to say correlate clinically.

Labs: Serum Ca+ 4, ionized Ca+ 2; Phos 13. H/H is slightly decreased at like 11/31, but otherwise everything else was unremarkable.

Kid drops pressure to 65/20, responds to fluild bolus. Drops again, and again another bolus is given and it comes up to 90/60. He has intermittent episodes of lethargy and extreme somnolence. Physical exam and neuro checks are unremarkable entire time. Calcium gluconate given. Kid goes to PICU. Mom mentions she has a thalassemia "and they thought he had it too, but we didn't get him tested as a baby." Radiology calls back 2 hours later and says they are pretty certain it's calcium deposits on CT scan.

And now we wait.
Thoughts?

 

[gutonc]

CT head: 2cm right sided hyperdense lesion at the globus pallidus, initially determined by radiology to be either 1) bleed or 2) calcification. They're not quite sure, and call to say correlate clinically.

Thoughts?

In med school I used to joke that I wanted to be an idiopathologist. Now I realize that's a real thing called a radiologist.

"Wow...that's some crazy-ass $hit up there in the brain/chest/abdomen...recommend clinical correlation."

 

[pianoman511]

I hate to use wikipedia as a source, but this does sound promising (although rare)

http://en.wikipedia.org/wiki/Fahr's_syndrome

 

[Dimoak]

This sort of like parathyroid disease.

 

[GoBuckeyes913]

Sooooo.... found out the kid's PTH is normal and also has confirmed alpha thalassemia. WEIRD! From what I looked up, the thalassemia can cause hypocalcemia....but at 10years old? Seems a little late. This is kinda out of the realm of EM (and my scope of knowledge), just didn't know if anyone had any more info.