ISSN - 0973-0958

Pediatric Oncall Journal

A 13 month old girl with head lag

A 13 month old girl with head lag

Dr Ira Shah.
Medical Sciences Department, Pediatric Oncall, Mumbai, India.

Dr Ira Shah, Medical Sciences Department, Pediatric Oncall, 1, B Saguna, 271, B St. Francis Road, Vile Parle {W}, Mumbai 400056.
Clinical Problem
Case Report: - A 13 month old girl born of non-consanguineous marriage presented with head lag since 1 day. She had diarrhea for 5-6 days, 1 week back for which she was treated with Injection Amikacin. She had no similar episodes in the past. She was immunized till date and had not received any polio-vaccine recently. Her milestones were normal. Family history was insignificant. On examination, there were no signs of dehydration. Her vital parameters were normal and there was no respiratory distress. She had hypotonia with normal power in all 4 limbs. There was no focal neurological deficit or any cranial nerve palsy except for head lag. Her deep tendon reflexes were normal and planters were extensors. Other systemic examination was normal.

What is the diagnosis?
Expert's opinion: This child has presented with head lag of sudden onset. She had no other muscle weakness though she has hypotonia. Also, she has no convulsions, cranial nerve involvement and hence central nervous system pathology such as brainstem encephalitis, space occupying lesion seems unlikely. Also with normal deep tendon reflexes and no evidence of an ascending paralysis, Guillian Barre syndrome seems unlikely. She has been completely immunized till date and thus has received over 4 oral polio vaccines and thus poliomyelitis also seems unlikely. Since this child had a preceding diarrhea that required IV antibiotics, a possibility of hypokalemia leading to muscle paralysis is a possibility. This hypokalemia could be due to enteral losses of potassium or could be due to familial periodic paralysis. However since she has had no similar episodes in the past and family history is also insignificant, familial periodic paralysis seems unlikely. Thus, most likely the child has hypokalemic induced head lag due to potassium losses in the stool.
On investigation, this child indeed had hypokalemia [serum potassium = 2.2 mEq/L]. Her venous blood gas was normal and urinary potassium was also normal ruling out renal tubular losses of sodium. Parents’ electrolytes were normal. She was treated with potassium supplements following which her head lag disappeared. After correction of hypokalemia and after omission of potassium supplements, her serum potassium continued to remain normal.
Compliance with ethical standards
Funding:  None  
Conflict of Interest:  None
Cite this article as:
Shah I. A 13 month old girl with head lag. Pediatr Oncall J. 2006;3: 36.
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