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A 11-year-old girl presents with concerns of headache. Parents report that the child has been complaining of headaches for the past 7 months. The headache is described as aching, located mostly all over. Severity is rated as 8 out of 10. It is precipitated by school work, worse after physical exertion.  It is alleviated by resting in a dark room with some improvement. There is no associated fever. The patient is also experiencing dizziness. Parents report that she bumped their head 2 weeks ago.  Family history is positive for bipolar disorder in older sibling. Social history reveals recent death of a grandparent. Physical Examination:  The child appears ill at ease and is alert. Head and neck exam: Neck is normal, Cranial nerves are normal. Focused neurological exam: Motor exam shows good tone and strength bilaterally. Reflexes are 1+ in the lower limbs and 2+ in the upper limbs. Sensory exam is normal. Cerebellar testing shows normal finger nose testing. Gait is normal.

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Authors

Dr. Karen Forbes

Dr. Jade Hindie

jade.hindie@umontreal.ca

Reviewer

Dr. Hosanna Au