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

Year 2021, Volume: 43 Issue: 5, 547 - 551, 13.09.2021

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

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

Abstract

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.

Keywords

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

Abstract

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.

Keywords

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

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