Clinical Reasoning: A 14-year-old girl with headache, seizures, and confusion

Abstract

A 14-year-old girl without any relevant medical history was transferred to our institution due to worsening headache along with nausea, vomiting, and generalized tonic-clonic (GTC) seizures for 7 days. She was also noted to have multiple psychological and behavioral abnormalities for 1 day. Her headache was described as severe holocephalic pain aggravated when lying down and alleviated after vomiting. No throbbing or phonophobia/photophobia was observed. Her seizures occurred once or twice a day, lasting about 1 minute each and resolving spontaneously. Symptoms were refractory to rotundine (dopamine D1 receptor antagonist), azasetron (antiemetic), mannitol, oxcarbazepine, and phenobarbital.