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JAMA Pediatrics Clinical Challenge |

A 15-Year-Old Boy With Trisomy 21 and Postoperative Weakness QUIZ

Anisha Chandra Schwarz, MD, MS1 ; Catherine Amlie-Lefond, MD1
[+] Author Affiliations
1 Department of Neurology, Seattle Children’s Hospital and the University of Washington, Seattle
JAMA Pediatr. 2016;170(1):85-86. doi:10.1001/jamapediatrics.2015.1677.
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Four days following resection of a scrotal lipoma, a 15-year-old boy with trisomy 21 presented to the emergency department with somnolence, pain, and paucity of speech with right hand and face weakness. What is your diagnosis?

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Digital magnetic resonance imaging showing hyperintense T2/fluid-attenuated inversion recovery signal in the left frontal periventricular white matter, without hemorrhage or mass effect.
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Digitally reconstructed 3-dimensional magnetic resonance angiogram with distal internal carotid artery and proximal middle cerebral artery narrowing, which is marked on the left and mild to moderate on the right. “Smoke-like” collateral vessels were seen.
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