A 5-yr-old child has a 6-mo history of increasing difficulty in walking associated with urinary incontinence. Physical examination shows an alert child with increased deep tendon reflexes, clonus and bilateral Babinski reflexes in the lower extremities with grade 3/5 weakness symmetrically in all extremities

7-month-old girl is presented to the emergency department with gradual onset of fever, lethargy, and irritability. Her immunizations are up to date. Examination reveals a febrile infant who does not interact with the examiner and cries inconsolably. A lumbar puncture is performed, and the cerebrospinal fluid shows increase lymphocyte, normal sugar and mild elevation of protein

A mother brings in her otherwise healthy 4-year-old son because he was unable to walk since this morning. He had an upper respiratory tract illness with a fever 1 week ago. On physical examination, the boy appears well, but he complains of leg pains bilaterally. Examination reveals bilateral weakness in the lower limbs

During the health supervision visit for a healthy 4-month-old boy, you note that his head circumference is 46 cm (>98th percentile) and his length and weight are at the 50th percentile. He has mild frontal bossing and widely split cranial sutures. The fontanelle is flat. Arm and leg movements, tone, and reflexes are normal. In reviewing prior growth parameters, you note that his head circumference was at the 75th percentile at birth and the 90th percentile at 2 months

A 4 year old boy's parents complain that their child has difficulty walking. The child rolled, sat and first stood at normal ages and first walked at 13 months of age. Over the past several months however, the family has noticed an increase inward curvature of the lower spine as he walks and that his gait has become more waddling. On examination, the child is oriented and interactive with the physician with an average body built. Enlargement of his calves has been noticed

The parents of a 3-year-old child are worried about the child's apparent clumsiness with frequent falls and a waddling gait. The child had normal development of motor skills during the first year of life and has normal language development

A 9 year old girl is referred because of declining academic performance over the last 6 months. Her class teacher was concerned that she has been inattentive and disinterested. She often asks people to repeat what they have said. On examination she looks well

A 2-year-old boy brought by his parents with acute onset of high fever followed by convulsions, there is no history of headache or vomiting. On examination his temperature is 39.7, he is fully conscious with no convulsions, no neck rigidity but he has congested pharynx