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We report a child presenting with intermittent ophthalmoplegia and fluctuating ptosis and facial weakness whose evaluation revealed no evidence of myasthenia gravis but did reveal hyperthyroidism secondary to Graves disease. Successful treatment of the child’s endocrinopathy resulted in complete resolution of his presenting symptoms. Children presenting with ophthalmoplegia and ptosis without proptosis should be evaluated for hyperthyroidism if no evidence of a myopathy or disorder of neuromuscular junction transmission is found. [ABSTRACT FROM PUBLISHER]

Using vignettes of real cases and the SimulConsult diagnostic decision support software, neurologists listed a differential diagnosis and workup before and after using the decision support. Using the software, there was a significant reduction in error, up to 75% for diagnosis and 56% for workup. This error reduction occurred despite the baseline being one in which testers were allowed to use narrative resources and Web searching. A key factor that improved performance was taking enough time (>2 minutes) to enter clinical findings into the software accurately. Under these conditions and for instances in which the diagnoses changed based on using the software, diagnostic accuracy improved in 96% of instances. There was a 6% decrease in the number of workup items accompanied by a 34% increase in relevance. The authors conclude that decision support for a neurological diagnosis can reduce errors and save on unnecessary testing. [ABSTRACT FROM PUBLISHER]

The article describes the case of a 4 year old Caucasian boy with autism presented with a 2-day history of diarrhea followed by decreased urine output for a day. Stool culture showed Shiga toxin-producing E. coli and underwent 3 cycles of plasma exchange within the first 48 hours of presentation without improvement in neurological status. Eculizumab was initiated and his neurological status improved after the first dose and he was successfully weaned off pentobarbitol and midazolam infusions.