Headache and eye pain in a toddler: An unusual presentation of neuroblastoma

A boy in early childhood presented to the emergency department due to headache and eye pain. Blood pressure was not recorded with intake of vital signs. A CT head was obtained, which was negative. On return from CT, he was found to be in hypertensive emergency, with blood pressures of 190s/140s in all four extremities. A renal bladder ultrasound with Doppler showed a left retroperitoneal mass, and abdominal CT with contrast confirmed a mass consistent with a neuroblastoma. He was admitted to the PICU for blood pressure stabilisation and subsequently transferred to the oncology service where he was definitively diagnosed with neuroblastoma and started on chemotherapy. This case is an unusual presentation of a neuroblastoma as a hypertensive emergency. It highlights the importance of obtaining triage blood pressure for acute care paediatric patients and of creating a follow-up plan with families for abnormal readings and not prematurely attributing them to patient cooperation.