A two year old child presents with acute onset of fever of two days duration points towards in most probability of an acute infective process. Cough during the same two day period could indicate a focus of the infection being the lung. Did the child have chest retractions, tachypnea or otitis media indicating a source of infection like a CSOM (Brain abcess), Pneumonia (Pneumococcus, H. influenzae meningitis)? Was the child malnourished and have any symptoms or adult contact prior to the present illness (TB)? The acute hemiplegia and the absence of cranial nerve involvement indicates that there has been a sudden event (vasculitis, thromboembolic event)? In view of this does the child have any past of squatting, cyanosis, recurrent respiratory tract infections (Congenital heart disease with infective endocarditis), rash, joint pains or swellings or unexplained fevers (Connective tissue disorders), bony pains, bleeding gums, fever, swellings in the neck and abdomen (Leuckemia), small joint pains and swellings, abdominal pains or has a tribal background (sickle cell disease), red birth marks on the body especially the face or seizures in the past (Neurocutaneous markers of vascular malformations), poor development or poor IQ, tall and lanky, visual defects (Homocystinuria)? The vital signs are normal and there is no hypertension. Mild pallor is noticed and most important neurological signs point to an upper motor neuron lesion ( Babinski +, DTR present). The absence of Cranial nerve involvement indicates the focus less likely to be the brain stem, pons. The absence of seizures or coma indicate that the lesion is less likely to be the cerebral hemisphere. The dense hemiplegia probably indicates a less likelhood of a cerebral hemisphere or corona radiata lesion. The previous discussants decision and pin pointing the lesion to be the internal capsule and that of an upper motor neuron lesion seems to be perfect. Now we need to chase the etiology. CT scan, CSF study (CT and child's condition permiting), Hb, Peripheral Smear, ESR, ANA, LE cell, Urine for Homocystinuria, Dislocated lens and fundi changes on Ophthalmology consult, CXR, ECHO, Mantoux to begin investigations. Could you show us the CT pictures and request that you educate us on CT terminology and point to each finding along with explainations for each of the findings.
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