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Unusual case of stroke in childhood
  1. David Clifford Mawhinney1,2,
  2. Stephen Mullen3,
  3. Nicholas Clarke4
  1. 1 Department of Emergency, Southern Health and Social Care Trust, Portadown, UK
  2. 2 Department of Emergency, Royal Belfast Children's Hospital, Belfast, UK
  3. 3 Paediatric Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK
  4. 4 Department of Radiology, Royal Belfast Hospital for Sick Children, Belfast, UK
  1. Correspondence to Dr David Clifford Mawhinney, Emergency Department, Craigavon Area Hospital, Southern Health and Social Care Trust, Portadown BT63 5QQ, UK; dmawhinney05{at}

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You receive a prealert call from a paramedic team stating they are managing a 12-year-old girl with acute left-sided weakness. As you prepare for the patient’s arrival, you go through a list of potential differentials.

Question 1

Which of the following is not part of the differential list?

  1. Haemorrhagic stroke.

  2. Hypoglycaemia.

  3. Bell’s palsy.

  4. Migraine.

  5. Todds’ paresis.

Question 2

What is the recommended time to CT following this type of presentation to the emergency department?

  1. 15 min.

  2. 40 min.

  3. 60 min.

  4. 120 min.

  5. The time to CT is only applicable to adult patients.

The family report intermittent frontal headaches and vomiting for a week, with fever >38°C Celsius. She is noted to be alert with no concerns with airway, breathing or circulation. She is communicating in short sentences. Observations are within normal parameters. Blood sugar 7 mmol/L. Glasgow Coma Scale 14/15.

She had profound left-sided weakness including neglect.

You have …

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  • Twitter @drs_mullen

  • Contributors SM and DCM sharing responsibility for development of manuscript, article content and educational approach. NC provided imaging and corresponding labelling of salient abnormalities.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.