PUZZLER
Boy complains of acute onset twitching
VERONICA R JOHNSON, MD; VANESSA G CARROLL, MD

THE CASE

CREDIT: Getty Images/E+/microgen

An 8-year-old boy presents to the emergency department with acute onset of twitching. The child began experiencing uncontrollable tics involving his bilateral upper extremities and shoulders 2 hours prior to presentation, with no associated loss of consciousness. The episodes lasted up to 5 minutes, resolving spontaneously without any intervention. Two days earlier, the patient had complained of fatigue and bilateral leg pain following a 2-mile walk outdoors, which resolved with rest and hydration.