Diagnostic Dilemma

Vomiting, quadriparesis and tremors


Author: Pediatric Oncall
Question
A 4 years old boy presented with projectile vomiting for 3 months which subsided for 15 days in between, weakness of both lower limbs since 2 months which has now involved even the upper limbs for past one month and head lag for one month. There is inability to stand, walk and sit and child falls when made to sit. However the child is able to move all 4 limbs and there is no spasticity and mother finds the child to be `loose`. There is history of tremors at the onset of the disease. There is no fever, headache, seizures or cranial nerve involvement. There is no drug ingestion.

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