Case 31-2017: A 19-Month-Old Girl with Failure to Thrive

To the Editor: In the Case Record involving an emaciated 19-month-old girl with a ravenous appetite in whom the diencephalic syndrome was diagnosed, Curran et al. (Oct. 12 issue) 1 do not discuss why a neuro-ophthalmological evaluation to rule out intracranial hypertension was not performed. The marked findings on imaging, which showed compromise of the optic chiasm, obstruction of the right foramen of Monro, and hydrocephalus, strongly suggest that the child’s vision might have been affected and that nystagmus, papilledema, and neurodevelopmental delay might have been present. These signs and symptoms compel such clinical evaluations and were de rigueur before computed . . .