Akut Dissemine Ensefalomiyelite Bağlı Periferik Fasiyal Sinir Felci Gelişen Bir Çocuk Hasta

Yıl 2021, Cilt: 43 Sayı: 5, 547 - 551, 13.09.2021

Sumeyye Emel Yel , Coskun Yarar , Emre Kaplan Kursat Bora Carman

https://doi.org/10.20515/otd.784408

Öz

Akut dissemine ensefalomiyelit (ADEM), nörogörüntülemede multifokal demiyelinasyon lezyonlarının kanıtıyla birlikte yaygın nörolojik belirti ve semptomlarla karakterize, santral sinir sisteminin monofazik akut demiyelinizan bir bozukluğu olarak kabul edilir. Yaygın görülen semptomlar letarji, ateş, kusma, baş ağrısı, meningeal belirtiler ve nöbetlerdir. Nörolojik belirtiler arasında duyusal değişiklikler, çoklu kraniyal sinir tutulumu, kuadripleji ve parapleji, distoni ve koreiform hareketler, ataksi, nistagmus, mesane tutulumu, konuşma bozukluğu ve çift görme vardır. Periferik fasiyal sinir felci nadiren eşlik eder. Akut dissemine ensefalomiyelit ile sağ periferik fasiyal sinir felci gelişen 7 yaşındaki bir kız çocuğu olgusunu sunuyoruz. Hastaneye görme azlığı, depresif ruh hali, yürüme bozukluğu ve yüz ifadelerinde bozulma yakınmaları ile başvurdu. Horizontal ve vertikal nistagmus, sağ periferik yüz felci, ataksik yürüyüş ve derin tendon reflekslerinde artış vardı. Beyin omurilik sıvısı (BOS) incelemesi normaldi. Serebral manyetik rezonans görüntülemede (MRG) çoklu beyaz cevher lezyonları görüldü. Yüksek doz metilprednizolon pulse tedavisi ile klinik bulgularda belirgin bir iyileşme gözlemledik.

Anahtar Kelimeler

Akut dissemine ensefalomiyelit, fasiyal sinir felci, çocuk, yüksek doz metilprednizolon pulse tedavisi

A Pediatric Patient with Peripheral Facial Nerve Palsy Due to Acute Disseminated Encephalomyelitis

Öz

Acute disseminated encephalomyelitis (ADEM) is considered a monophasic acute demyelinating disorder of the central nervous system characterized by diffuse neurologic signs and symptoms coupled with evidence of multifocal lesions of demyelination on neuroimaging. The common presenting symptoms are lethargy, fever, vomiting, headache, meningeal signs, and seizures. Neurological manifestations included altered sensorium, multiple cranial nerve involvement, quadriplegia and paraplegia, dystonia and choreiform movements, ataxia, nystagmus, bladder involvement, speech defect, and double vision. Peripheral facial nerve palsy rarely accompanies. We describe the case of a 7-year-old girl who developed acute disseminated encephalomyelitis with right peripheral facial paralysis. She was admitted to the hospital with visual impairment, depressed mood, gait disturbance, and deterioration of facial expressions. She had horizontal and vertical nystagmus, right peripheral facial paralysis, ataxic gait, and hyperactive deep tendon reflexes. The cerebrospinal fluid (CSF) examination was normal. Cerebral magnetic resonance imaging (MRI) showed multiple white matter lesions. We observed a significant improvement in clinical findings with high dose methylprednisolone pulse therapy.

Anahtar Kelimeler

Acute disseminated encephalomyelitis, facial nerve palsy, child, high-dose methylprednisolone pulse therapy

Kaynakça

• Jayne MN. Demyelinating disorders of the central nervous system. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, Behrman RE editors. Nelson Textbook of Pediatrics. 20th ed. Philadelphia: Elsevier; 2016. pp. 2919–2925.
• Kaya A, Acikgoz M, Ustyol L, Avcu S, Sal E, Okur M, Caksen H. A case of acute disseminated encephalomyelitis mimicking leukodystrophy. Kurume Medical Journal. 2010;57(3):85-89.
• Madan S, Aneja S, Tripathi RP, Batra A, Seth A, Taluja V. Acute disseminated encephalomyelitis--a case series. Indian Pediatr. 2005;42(4):367-71.
• Garg RK. Acute disseminated encephalomyelitis. Postgrad Med J. 2003;79(927):11-7.
• Kinomoto K, Okamoto Y, Yuchi Y, Kuriyama M. Acute encephalomyelitis associated with acute viral hepatitis type B. Intern Med. 2009;48(4):241-3.
• Sidhu J, Maheshwari A, Gupta R, Devgan V. Acute Disseminated Encephalomyelitis After Plasmodium Vivax Infection: Case Report and Review of Literature. Pediatr Rep. 2015;7(2):5859.
• Jayakrishnan MP, Krishnakumar P. Clinical profile of acute disseminated encephalomyelitis in children. J Pediatr Neurosci. 2010;5(2):111–114.
• Ashrafi MR, Amirkashani D, Hirbod-Mobarakeh A, Yaghmaei B, Tavassoli A, Manafi F, Rezaei N. Acute disseminated encephalomyelitis mimicking acute meningoencephalitis. Acta Clin Croat. 2013;52(4):523-8.
• Murthy SN, Faden HS, Cohen ME, Bakshi R. Acute disseminated encephalomyelitis in children. Pediatrics. 2002;110(2Pt1):e21.
• Zeb Q, Alegria A. Acute disseminated encephalomyelitis (ADEM) following a H3N3 parainfluenza virus infection in a pregnant asthmatic woman with respiratory failure. BMJ Case Reports. 2014.
• Kumar P, Kumar p, Sabharwal RK. Acute Disseminated Encephalomyelitis: Case Report and Brief Review. J Family Med Prim Care. 2014;3(4):443-445.
• Al-Hanshani AA, Otaif MY, Shati AA, Alsuheel AM, Huneif MA. Acute Disseminated Encephalomyelitis Presenting with Ptosis and Facial Palsy. Med. J. Cairo Univ. 2014;82(1):269-272
• Thomas GS, Hussain IH. Acute Disseminated Encephalomyelitis: A Report of Six Cases. Med J Malaysia. 2004;59(3):342-51.
• Tripathy S, Routray PK, Mohapatra AK, Mohapatra M, Dash SC. Acute Demyelinating Encephalomyelitis After Anti-venom Therapy in Russell’s Viper Bite. J Med Toxicol. 2010;6(3):318-321
• Patra KC, Shirolkar MS, Ghane VR. Acute disseminated encephalomyelitis: Extremely rare presentation of pediatric human immunodeficiency virus infection. J Peadiatr Neurosci. 2014;9(2):150-153.
• Kaymakamzade B, Karabudak R, Kurne AT, Nurlu G. Acute Disseminated Encephalomyelitis after Oral Therapy with Herbal Extracts: A Case Report. Balkan Med J. 2016;33(3):366-369.
• Sheikh AAE, Sheikh AB, Sagheer S, Tariq U, Bukhari MM, Fatima Z, Afzal RM. Acute Intermittent Porphyria: A Rare Cause of Acute Disseminated Encephalomyelitis. Cureus. 2018;10(7):e2989.
• Garg RK. Acute Disseminated Encephalomyelitis. Postgrad Med J. 2003;79(927):11-17.
• Marchioni E, Tavazzi E, Minoli L, Del Bue S, Ferrante P, Piccolo G, Bastianello S, Ravaglia S. Acute Disseminated Encephalomyelitis. Neurol Sci. 2008;29:286-288
• Lee YJ. Acute disseminated encephalomyelitis in children: differential diagnosis from multiple sclerosis on the basis of clinical course. Korean J Pediatr. 2011;54(6):234-240.
• Mader I, Stock KW, Ettlin T, Probst A. Acute disseminated encephalomyelitis: MR and CT features. AJNR Am J Neuroradiol. 1996;17(1):104-109.