Spontaneous headache of sudden onset in a child resulting in death in less than four hours would most probably be due either to acute bacterial meningitis or subarachnoid haemorrhage. In this particular case the absence of fever, lack of other constitutional symptoms and speed of onset and progression make subarachnoid haemorrhage the preferred diagnosis. Given the age-group arteriovenous malformation rather than berry aneurysm is the more likely underlying pathology. In 2 Kings 4:34 we read that Elisha 'got on the bed and lay upon the boy, mouth to mouth, eyes to eyes, hands to hands'. There is no mention of artificial respiration or cardiac compression and the boy's recovery was clearly miraculous, not due to 'inspired CPR' as some commentators have suggested.
Differential Diagnosis 2
In 1 Samuel 5 & 6 God sends a disease upon the Philistines for stealing the Ark of the Covenant. We read that he 'brought destruction upon them and afflicted them with tumours' (1 Sam 5:6). The Philistine priests and diviners suggested that making 'models of the tumours and of the rats' which were 'destroying the country' would avert God's wrath (1 Sam 6:5). On the basis of the evidence in the passage are these 'tumours' more likely to be neoplastic or inflammatory? What is the most likely diagnosis and underlying cause?Luke's opinion in next issue.
