ABSTRACT
We report a case of a 12-year-old girl who presented with acute-onset diplopia, dizziness, and upbeat nystagmus. On examination, she had right internuclear ophthalmoplegia with right eye hypertropia and exotropia and impaired convergence. In addition, she also had spontaneous primary position symmetric upbeat nystagmus. In this report, we discuss the clinical approach with meticulous neuro-ophthalmologic examination and neuroanatomic localization in pediatric patients with acute-onset diplopia.
Subject(s)
Nystagmus, Pathologic , Ocular Motility Disorders , Female , Humans , Child , Dizziness/complications , Dizziness/diagnosis , Diplopia/diagnosis , Diplopia/etiology , Nystagmus, Pathologic/diagnosis , Nystagmus, Pathologic/etiology , Ocular Motility Disorders/diagnosis , Vertigo/complications , Vertigo/diagnosis , Clinical ReasoningABSTRACT
SARS-CoV-2 continues to develop new, increasingly infectious variants including delta and omicron. We evaluated the efficacy of the Abbott BinaxNOW Rapid Antigen Test against Reverse Transcription Polymerase Chain Reaction ("RT-PCR") in 1054 pediatric participants presenting to a high-volume Coronavirus Disease 2019 (COVID-19) testing site while the delta variant was predominant. Participants were grouped by COVID-19 exposure and symptom status. RT-PCR demonstrated an overall prevalence of 5.2%. For all participants, sensitivity of the BinaxNOW was 92.7% (95% CI 82.4%-98.0%) and specificity was 98.0% (95% CI 97.0%-98.8%). For symptomatic participants, positive predictive value (PPV) was 72.7% (95% CI 54.5%-86.7%) and negative predictive value (NPV) was 99.2% (95% CI 98.2%-100%). Among asymptomatic participants, PPV was 71.4% (95% CI 53.7%-85.4%) and NPV was 99.7% (95% CI 99.0%-100%). Our reported sensitivity and NPV are higher than other pediatric studies, potentially because of higher viral load from the delta variant, but specificity and PPV are lower. ImportanceThe BinaxNOW rapid antigen COVID-19 test had a sensitivity of nearly 92% in both symptomatic and asymptomatic children when performed at a high-throughput setting during the more transmissible delta variant dominant period. The test may play an invaluable role in asymptomatic screening and keeping children safe in school.