ICNTN-FLICNA Clinical Case Club
By ICNApedia
April 18, 2022
0:00 / 56:09
ICNTN-FLICNA Clinical Case Club
Shermila Pia

Okay, can everybody see the screen? Okay. So thank you so much for the introductions. I'm Shermila Pia. I'm one of the third year residents at University of Rochester. Thank you for introducing all of my colleagues who are listed here. Dr. Stone, Dr. Ellica. Dr. Korones may join if he's able to.

So I gonna kind of jump right into our case here? This is the story of an 11 month old boy who presented to us after his parents had noted some right-hand preference starting at about four months old, he would only reach for objects with his right hand and he would prefer to keep that left hand in a fist.

He seems to be pretty unsteady when he's sitting and will only catch himself if he leans towards the left. In terms of his development for his motor skills, he will briefly sit up. He can't yet crawl. He is able to pull to stand, but won't take any steps. In terms of fine motor, he keeps his left hand with the thumb tightly adopted into the Palm, and then he can extend the fingers.

He has a normal pincer grip on the right side. In terms of his speech and social development. Really no concerns. He's saying his first words already and he's playing peek-a-boo and smiling. Some more history about his birth. So the pregnancy itself was complicated by maternal nicotine use and some mild anemia.

But he was born at 39 weeks and two days via an unscheduled C-section due to failure to progress. His initial APGARS were nine and nine and there was no complications with his neonatal course in terms of social history. He is watched full-time by his parents. He has a three-year-old sister at home.

He doesn't have any medical issues. He's up-to-date on his immunizations and his family history is pretty unremarkable. Mom has migraines. Dad has a question of some ADHD and his three-year-old sister is healthy. Any questions on this brief history before we move to his physical exam?

Okay. Here's his exam at 11 months old, as you can see, he's on the smaller side, but he's playful and interactive the most notable part of his exam this time. His motor exam. So he had some hypertonia of the left arm and left leg. He holds that left hand in a fist and won't reach with that side or catch himself when unsteady.

He also couldn't really sit up for more than a minute at a time. His reflexes on that left side were also increased both in the arm and the leg.

So I wanted to open it up for thoughts on differential diagnosis at this point, and maybe what the next steps and work up would be.

Robert Stone

We can have people just enter their thoughts in the chat.