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Multiple sclerosis with early childhood onset. A case report
M I Vergani1, R Reimão, A M Silva
1Department of Neurology, University of São Paulo School of Medicine, Brasil.
Insights
Pediatric multiple sclerosis (MS) can present with neurological deficits like ataxia and hearing loss. Early diagnosis is crucial, supported by imaging and cerebrospinal fluid analysis, even in young children.
Area of Science:
- Pediatric Neurology
- Neuroimmunology
- Clinical Diagnostics
Background:
- Multiple sclerosis (MS) is typically diagnosed in adults, but rare cases occur in early childhood.
- Diagnosing pediatric MS presents challenges due to overlapping symptoms with other neurological conditions.
Observation:
- A 2-year-old boy experienced subacute ataxic gait and hearing loss, with elevated cerebrospinal fluid (CSF) gamma globulins.
- A subsequent episode at age 5 showed appendicular ataxia, gaze deviation, white matter lesions on CT, abnormal evoked potentials, and altered T lymphocyte subsets.
Findings:
- The patient exhibited recurrent neurological episodes with visual, cerebellar, brainstem, and paraventricular involvement.
- Diagnostic support included abnormal CSF gamma globulin levels, T lymphocyte subset analysis, and neuroimaging (CT).
- Evoked potentials studies revealed abnormalities in both auditory and visual pathways.
Implications:
- The clinical presentation and diagnostic findings strongly suggest multiple sclerosis (MS) in this pediatric patient.
- This case highlights the importance of considering MS in young children presenting with unexplained neurological symptoms and relapsing-remitting courses.
- Early identification and diagnosis of pediatric MS are critical for timely intervention and management.
Abstract:
A 2 year old boy was admitted owing to a subacute episode of ataxic gait and hearing deficit. Computerized tomography (CT) was normal and cerebrospinal fluid (CSF) analysis revealed gamma globulins level of 15.4% (normal 7 to 14%). There was spontaneous remission after 7 months. At 5 years of age the boy incurred a second episode with predominantly right appendicular ataxia and tonic gaze deviation to the right side. CT showed a low-density lesion in the white matter adjacent to the right frontal horn. Visual and auditory evoked potentials were abnormal. CSF revealed a mild increase in gamma globulins level of 14.5% with an abnormal T lymphocyte subsets study. The combination of visual, cerebellar, brain stem and paraventricular lesions with clear remissions and exacerbations, supported by CT, CSF and evoked potentials findings suggests the diagnosis of multiple sclerosis even at this early age.