Paediatric rhombencephalitis presenting with bradycardia: a good recovery despite cardiac involvement

Area of Science:

• Neurology
• Infectious Diseases
• Pediatrics

Background:

• Rhombencephalitis is a rare, often infectious, neurological condition.
• It typically presents with myoclonic jerks, ataxia, and cranial nerve palsies, carrying high morbidity and mortality.
• Cardiopulmonary involvement is associated with a worse prognosis.

Observation:

• A 10-year-old boy presented with headache, vomiting, symptomatic bradycardia, and rapidly progressing sixth nerve palsy.
• This presentation lacked typical brainstem symptoms like myoclonic jerks or ataxia.
• Bradycardia is an atypical finding in previously reported rhombencephalitis cases.

Findings:

• The patient experienced a rapid onset of neurological symptoms, including ophthalmoplegia.
• Despite extensive screening, the specific viral cause of rhombencephalitis remained unidentified.
• Treatment involved intravenous antibiotics and antivirals, leading to a good clinical outcome.

Implications:

• Rhombencephalitis should be considered in pediatric cases with rapid neurological decline, especially with cranial nerve palsies.
• The case expands the spectrum of clinical presentations for rhombencephalitis, including symptomatic bradycardia.
• Prompt diagnosis and treatment are crucial for favorable outcomes in pediatric rhombencephalitis.