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  1. M. Mancao1,
  2. K. Savells1,
  3. A. Martino1,
  4. T. Ricke1
  1. 1Departments of Pediatrics and Neurological Surgery, University of South Alabama, Mobile, AL.


Introduction Gait disturbance in a child could be secondary to infection, trauma, or malignancy. We therefore present an unusual case of a 13-month-old child who presented with persistent limping and inability to bear weight on his left lower extremity and subsequently was diagnosed with Chiari type I malformation.

Case Report A 13-month-old child was admitted twice to the hospital for inability to bear weight on his left lower extremity. During his first hospitalization, he underwent ultrasonography and aspiration of his left hip; both tests yielded negative results, and he was diagnosed with toxic synovitis of his hip and discharged home on naproxen. He was readmitted 1 week later due to persistent limping. Magnetic resonance imaging (MRI) of the thoracolumbar spine was performed and revealed possible Chiari malformation; therefore, follow-up MRI of the brain and cervical spine was done and confirmed the Chiari malformation type I with 8 mm herniation of the cerebellar tonsils below the foramen magnum. The patient was sent home but was readmitted 6 days later due to persistent limping. The patient then underwent craniotomy and repair of the Chiari malformation. Postoperatively, the patient presented with fever up to 103°F and drainage from his craniotomy site. Cerebrospinal fluid analysis was performed that revealed white blood cell count of 20 cells/μL (68% lymphocytes, 28% monocytes, and 4% eosinophils), red blood cell count of 85,750 cells/μL, protein of 523 mg/dL, and glucose of 66 mg/dL. He was diagnosed with aseptic meningitis and given a 5-day course of oral prednisone. He defervesced and was sent home. Two days later, he was readmitted for fever to 104°F and mild diarrhea. Laboratory workup later revealed he had an adenoviral infection, and he was discharged home once stable. He returned back to the hospital 2 days later because of fever to 102°F and was again noted with watery stools. He was discharged home after 2 days. He has since been seen at the neurosurgery clinic for follow-up and has done well, with improved gait and no recurrence of fever.

Conclusions This case illustrates the need to keep a high index of suspicion for other causes of gait disturbance, such as Chiari malformation, and that persistent symptoms warrant an extensive workup, including an MRI of the brain and spine. It is also interesting to note that there are patients with persistent fever after craniotomy with negative CSF studies who eventually do well.

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