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Abbreviations: ALT: alanine aminotransferase • AST: aspartate aminotransferase • BUN: blood urea nitrogen • CBC: complete blood count • CNS: central nervous system • CSF: cerebrospinal fluid • CT: computed tomography • ECG: electrocardiography • ED: emergency department • EEG: electroencephalography • ESR: erythrocyte sedimentation rate • GI: gastrointestinal • GU: genitourinary • Hct: hematocrit • Hgb: hemoglobin • MRI: magnetic resonance imaging • WBC: white blood cell

The first 300 words of the full text of this article appear below.

	Case 1 Presentation

 
A previously healthy 9-year-old girl presents with a 1-week history of intermittent confusion, dysphagia, visual changes, and involuntary movements of the face and left hand. During this period, she has had two episodes of disorientation and memory loss that were not associated with alteration in consciousness or behavioral changes. The involuntary movements of the left arm and leg have become progressively worse throughout the week. The facial movements are described as lip smacking and excessive blinking. Four days ago, she complained of one episode of diplopia. She denies nausea, vomiting, fever, symptoms of upper respiratory tract infection, numbness, or weakness. There is no history of trauma, ingestion of toxic substances, recent illness, sick contacts, or recent travel.

She has a history of occasional mild headaches that respond to acetaminophen. She takes no other medications. Head CT scan performed in the past to evaluate her headaches yielded normal results. Her birth history and development are normal. Immunizations are up to date. Her mother suffers from migraine headaches, and her maternal great grandfather has Parkinson disease and had a stroke in his 40s.

Her vital signs are within the normal range for age. On physical examination, she has excessive blinking, lip smacking, chorea of the left upper extremity, mildly diminished strength in the left upper and lower extremities, and mild ataxia. Imaging and laboratory studies reveal the cause of the chorea and the underlying condition.

	Case 2 Presentation

 
A 19-day-old boy presents to the ED with a 5-day history of rhinorrhea, nasal congestion, dry cough, and labored breathing. His mother reports two episodes when he became jittery, turned dusky and limp, frothed at the mouth, and experienced upward rolling of the eyes. He was born at term and had an uneventful nursery course. His mother is healthy, and his family medical history is unremarkable. He . . . [Full Text of this Article]

Mary Vo, MD, PharmD
Weill Cornell Medical Center, New York, NY

Aarat M. Patel, MD
University of Pittsburgh/Children's Hospital of Pittsburgh, Pittsburgh, Pa

Valeriy Chorny, MD
Jaspreet Sood, MD
Kings County Hospital Center, SUNY Downstate Medical Center, Brooklyn, NY

Thomas J. Klein, MD, PhD
Susan Chhabra, MD
Inova Fairfax Hospital, Fairfax, Va

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