Related Experiment Video
Updated: Sep 18, 2025
Intracerebroventricular and Intravascular Injection of Viral Particles and Fluorescent Microbeads into the Neonatal Brain
Published on: July 24, 2016
Enteroviral Transverse Myelitis Presenting as Acute Ataxia in Children: A Case Series
Luka Švitek1,2, Dominik Ljubas3, Nina Krajcar3
1Department of Infectology and Dermatovenerology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia.
Abstract:
Background: Enteroviruses, members of the Picornaviridae family, typically cause asymptomatic or mild infections. However, they can also result in central nervous system (CNS) involvement, with transverse myelitis (TM) occurring only on rare occasions. TM is a syndrome characterized by acute or subacute spinal cord dysfunction, leading to neurological deficits below the level of the lesion. Case report: We report a case series of eight pediatric patients admitted over a three-month period, June to August 2024. All patients presented with ataxia and/or other neurological symptoms, alongside abnormal cerebrospinal fluid (CSF) findings. Although ataxia is commonly associated with cerebellitis, magnetic resonance imaging (MRI) in this cohort revealed findings consistent with TM. Notably, all patients demonstrated similar MRI abnormalities. The onset of symptoms occurred over a short time during an enterovirus epidemic. Enteroviral RNA was detected, or the virus was isolated in seven patients, while one patient had a close epidemiological link to the virus. All patients achieved full recovery following immunomodulatory therapy. Conclusions: This case series underscores that ataxia may be an atypical symptom associated with TM. Furthermore, there was a notable distinction between the clinical presentation and neuroradiological findings. Immunomodulatory therapy with immunoglobulins and corticosteroids has been shown to be effective and safe, supporting the hypothesis of an immune-mediated pathogenesis in these patients.
Insights
Enteroviruses can cause transverse myelitis (TM) presenting atypically with ataxia in children. Prompt immunomodulatory therapy led to full recovery, suggesting an immune-mediated process.
Area of Science:
- Neurology
- Virology
- Pediatrics
Background:
- Enteroviruses, part of the Picornaviridae family, usually cause mild infections but can lead to central nervous system (CNS) disease.
- Transverse myelitis (TM) is a rare but severe spinal cord inflammation causing neurological deficits.
- Pediatric TM is uncommon, and its presentation can be atypical.
Purpose of the Study:
- To describe a case series of pediatric patients with transverse myelitis (TM) presenting with ataxia.
- To investigate the association between enterovirus infection and atypical TM presentation in children.
- To evaluate the efficacy of immunomodulatory therapy in pediatric TM.
Main Methods:
- Retrospective case series of eight pediatric patients admitted between June and August 2024.
- Clinical assessment, cerebrospinal fluid (CSF) analysis, and magnetic resonance imaging (MRI) were performed.
- Enteroviral RNA detection or isolation was conducted; epidemiological links were assessed.
Main Results:
- Eight pediatric patients presented with ataxia and neurological symptoms during an enterovirus epidemic.
- MRI revealed findings consistent with TM in all patients, despite ataxia being the primary symptom.
- Enterovirus was detected in seven patients, with one having close contact; all patients recovered fully with immunomodulatory therapy.
Conclusions:
- Ataxia can be an atypical presenting symptom of transverse myelitis (TM) in children.
- A discrepancy between clinical presentation (ataxia) and neuroradiological findings (TM) was observed.
- Immunomodulatory therapy (immunoglobulins, corticosteroids) is effective and safe, supporting immune-mediated pathogenesis in enterovirus-associated TM.
