Clinical Reasoning: A 6-Year-Old Girl With Right-Sided Pain and Weakness.
Cristina M GaudiosoRachel ZolnoAnne WagnerSoe MarPublished in: Neurology (2022)
We outline a case of a 6-year-old girl presenting with a two-week course of waxing and waning neurologic symptoms, including right-sided pain, weakness, dizziness, and difficulty walking. Her exam was notable for right-sided weakness, hyperreflexia, and dysmetria. Diagnostic evaluation was significant for MRI with numerous T2-hyperintense, T1-hypointense, and T1-enhancing lesions located in the juxtacortical and periventricular regions, corpus callosum, brainstem, and spinal cord; positive CSF oligoclonal bands; negative serum aquaporin-4 IgG and myelin oligodendrocyte glycoprotein IgG; and positive serum Epstein Barr virus viral capsid antigen IgG.This case highlights the evaluation indicated for a pediatric patient presenting with a possible demyelinating disorder and the nuances of diagnosing these conditions in pre-pubertal children in particular. Thoughtful clinical, laboratory, and radiographic investigation is needed for accurate diagnosis in order to initiate appropriate therapies.
Keyphrases
- epstein barr virus
- spinal cord
- chronic pain
- neuropathic pain
- pain management
- diffuse large b cell lymphoma
- magnetic resonance imaging
- sars cov
- case report
- young adults
- multiple sclerosis
- high resolution
- randomized controlled trial
- physical activity
- white matter
- depressive symptoms
- sleep quality
- diffusion weighted imaging