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Hemiballismus revealing multiple sclerosis in an infant
M Giroud1, D Semama, L Pradeaux
1Service de Neurologie, Hôpital Général, Dijon, France.
Insights
This case report details a rare instance of infant multiple sclerosis (MS) presenting with hemiballismus and optic neuritis. Early diagnosis and treatment are crucial for managing pediatric MS symptoms.
Area of Science:
- Neurology
- Pediatrics
- Neuroimmunology
Background:
- Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system.
- Pediatric MS is rare, with limited case studies, especially in infants.
- Hemiballismus, a hyperkinetic movement disorder, is an uncommon initial presentation of MS.
Observation:
- A 15-month-old infant presented with acute left hemiballismus, Marcus-Gunn pupil, and retrobulbar optic neuritis.
- Symptoms resolved spontaneously within a week, followed by paraparesis and left sixth cranial nerve palsy.
- Cerebrospinal fluid analysis revealed elevated white blood cells and oligoclonal bands, indicative of central nervous system inflammation.
Findings:
- The clinical presentation and diagnostic findings strongly suggest definite multiple sclerosis in an infant.
- Hemiballismus as the initial symptom in pediatric MS is exceptionally rare.
- Abnormal evoked visual potentials further supported the diagnosis of demyelinating disease.
Implications:
- This case highlights the diverse and unusual initial presentations of multiple sclerosis in infancy.
- It underscores the importance of considering MS in infants with unexplained neurological deficits.
- Further research into early-onset MS is needed to understand its unique pathophysiology and optimize treatment strategies.
Abstract:
The authors report a case of a 15-month-old infant who presented a left hemiballismus associated with left Marcus-Gunn pupil, and retrobulbar optic neuritis, which disappeared spontaneously in 7 days. Six weeks later, the infant experienced a mild paraparesis with a palsy of the left sixth cranial nerve, which disappeared following steroid therapy. Evoked visual potentials elicited abnormal latencies; cerebrospinal fluid (CSF) showed a rise in white cells and oligoclonal bands. According to the usual classification, this case corresponds to definite multiple sclerosis. The fact that hemiballismus was the initial clinical feature in an infant makes this observation very interesting. In the literature, eight cases of hemiballismus in patients with multiple sclerosis are reported; however, only two cases of multiple sclerosis in infancy have been published, making our case report of particular interest.