Fao Sqad.

[NoMercy]

I would be greatly interested to hear your thoughts in a case which is proving to be a diagnostic dilemma.

13 year old boy with 17 week history of vomiting, fits, anxiety, sleeping problems and lapses in concentration. Is receiving home schooling due to acute onset of symptoms. Home tutor now reports acute regression and boy is no longer able to write his own name, count to 5, or converse or interact with her to any useful extent. Mum reports he is now seeing "ghosts" and hearing voices.

He is not on any regular medication. Strong family history of mental illness (mother, father and maternal grandmother). Bloods and MRI head entirely normal.

Mental illness doesn't really explain fits and vomiting...

Eagerly anticipate your thoughts...

[bednobs]

has he had an eeg?

[bednobs]

hi, sorry hi am not sqad but was also just wondering if fits have been witnessed by a professional at all? (am thinking psuedo-fits) Also, you say mother and father both mental illness - are they currently looking after the 13 yo?

[pixie373]

I'm not sqad either, sorry. But all of these symptoms could be caused by brain problems. The vomiting could be part of the anxiety and fits could indicate infection or damage in the brain. The obvious suspect as far as hallucinations go would be schizophrenia, but i assume all the obvious causes are being looked at already.
Have the healthteam given you any ideas so far?
Sqad does like a good history, so maybe you could say which mental illnesses his relatives have?
Must be heartbreaking. Lots of love to him xx

[Sqad]

Hi NoM.

Blimey I don't think that i can offer anymore than bednobs and pixie have suggested.
The first thing to do is to exclude an organic cause and it would seem that a normal MRI scan would have exclude a cerebral tumour.
I presume that he would have had a lumbar puncture and if that was normal, meningitis or encephalitis would be excluded.

Like pixie says....a psychosomatic or psychiatric diagnosis does seem to be in the "frame."

I will cogitate further NoM and get back to you if anything comes to mind.

keep me informed as it is quite a diagnostic challenge.

[Sqad]

NoM I have cogitated further and can only say that i agree with my compatriots above, that it is extremely unlikely to be of an organic nature.

[anneasquith]

im not sqad or a doctor, but even if mri normal ( how long ago was it done )/ sounds like brain tumour IMO.

[NoMercy]

Hi Sqad.

I have no further information other than onward referral to the Psychiatry Team has been made. A similar case recently turned out to be severe intracranial pressure but that's been ruled out in this case.

Thanks everyone for your replies.

[Sqad]

Thanks....would be interested in the Psychiatric opinion.

[pizza]

NoM my thoughts are with this young boy and his family, hope he gets the help and treatment he needs.

[Rosetta]

sqad, would an MRI show evidence of epilepsy?

[Sqad]

Rosette.......only if the epilepsy was due to a space occupying lesion i.e tumour.

The vast majority of patients with epilepsy do not have a tumour and the diagnosis of epilepsy is made on an EEG (electro-encephologram.)

[Rosetta]

Thanks Sqad. Hopefullly the team will do an EEG, to rule it out if nothing else

[Sqad]

Rosette......indeed.

[EcclesCake]

Society, I think calling for Gregory House might be a more useful approach.

[lcg]

vomiting/fits can be part of somatic symptoms or conversion disorder. particularly the latter....and would fit with anxiety disorders. just a thought.

[lcg]

http://en.wikipedia.org/wiki/Conversion_disorder

[lcg]

meant to add this one as well.....
http://en.wikipedia.org/wiki/Somatization_disorder

[evilly]

Have you made an appointment to see a psychiatrist? He could be psychotic but I hope this is not the case. Sometimes vomiting and fits can be a result if upsetting thoughts