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P22.13 Acute cerebellar ataxia due to Lyme disease
S122
Poster sessions
positive. On day three of the illness she was noted to have progressively deteriorating hypotonia and mutism. There were no features of encephalopathy. Despite her inability to speak she was able to demonstrate appropriate emotional responses with preserved laughter and crying. Over the following week she developed truncal ataxia and dysmetria. Four months after the event, she has shown good recovery with normal symmetrical motor functions and coordination. She continues to have minimal speech disturbance. CSF analysis was normal with negative viral PCR. MRI brain with diffusion weighted images showed bilateral, symmetrical hyper intensity of the grey matter of both cerebellar hemispheres. There are few reported cases of cerebellitis following Rotaviral diarrhoea. Most of the cases with neurological complications following Rotaviral infection have negative CSF serology. The pathogenesis remains poorly understood in such cases. Our case demonstrates typical clinical and MRI findings of acute cerebellitis, a rare complication of a common childhood illness.
the quarter of cases. As both infectious and inflammatory mechanisms could be implicated in the AIS following VZV, antiviral and anti-inflammatory drugs could have potentially therapeutic role. Case report: We present the case of 7-year-old boy who developed slight left hemiparesis two weeks after chickenpox. Symptoms of hemiparesis gradually regressed during the first day but five days later left hemiparesis reoccurred. Brain imaging showed hypodensity in the basal ganglia which is the most common localization affected by VZV. The patient was treated with acyclovir and methylprednisolone. Short and long term prognosis has showed gradual regression of the clinical and radiological changes. Conclusion: Acute arterial ischemic stroke, especially recurrent, should be suspected as a complication of VZV infection in case of typical middle cerebral artery infarction with the changes in the basal ganglia even in the late period after VZV infection as recognition of specific aetiology can influence treatment strategy.
P22.11 EEG as a predictor of Lyme disease in a child with a peripheral facial palsy
I. Erol1 , S. Saygi1 , F. Alehan1 *. 1 Department of Pediatrics, Division of Child Neurology, Baskent University Faculty of Medicine, Turkey
P22.13 Acute cerebellar ataxia due to Lyme disease
1 ˇ M. Malenica1 *, Lj. Cvitanovic, R.G. Juraˇski1 , G. Teˇsovic´ 2 . ´ Sojat Neuropediatrics Department, University Hospital Sestre Milosrdnice, Zagreb, Croatia, 2 University Hospital for Infectious Diseases “dr.Fran Mihaljevi´c”, Zagreb, Croatia 1
Background: Although EEG changes in encephalopathies are known, diagnostic criteria for possible, probable, or definite neuroborreliosis still do not include EEG findings. Aim of the study: We suspected neuroborreliosis in a patient with peripheral facial palsy without history of a tick bite using EEG findings. Methods: Blood count and serum chemistry, serum and liquor serology, ECG, EEG, MRI of the brain, cardiology, dermatology, ophtalmology and physiatric consultation were done during the course of the disease. Results: The patient presented with peripheral facial palsy as single symptom. Brain MRI, blood count and serum chemistry showed no abnormality. EEG on day 6 demonstrated nonspecific generalized slowing, focal centrofrontal slowing, and grouped high voltage parieto-occipital bilateral slow waves, vulnerable to hyperventilation, with no epileptiform activity. We suspected Lyme disease, and with later development of erythema migrans, fever, malaise and positive serology for Borrelia burgdorferi in serum and liquor neuroborreliosis was confirmed. Serology for tick-borne encephalitis was negative. Because of the left hemiblock on ECG, ECHO was performed. The patient received 2g of ceftriaxone i.v. for 14 days. EEG findings were normalized and facial nerve function restored. Conclusion: Our patient who presented with peripheral nerve palsy and no history of tick bite had EEG changes which led us to investigate for and prove Lyme disease. Our case is a further confirmation that EEG findings could be indicative of Lyme disease. P22.12 Childhood cerebral infarction following varicella zoster virus infection N. Vaiciene-Magistris1 *, J. Grigoniene1 , P. Barkauskiene1 . 1 Lithuanian University of Health Sciences, Lithuania Introduction: Neurological complications of the common varicella zoster virus (VZV) infection are rare and include cerebellar ataxia, encephalitis, meningitis, optic neuritis, myelitis, vasculitis and very rarely arterial ischemic stroke (AIS). Clinical symptoms of stroke may occur 1 week to 12 months after varicella disease. The majority of the patients have infarction in the middle cerebral artery. The recurrent transient ischemic attacks or new infarcts occur in
Introduction: Lyme disease is an infectious disease caused by the Borrelia spirochaetes, usually transmitted to humans by the Ixodes ticks. It is manifested by a wide spectrum of clinical symptoms. Cerebellar involvement in Lyme disease is a known but rare manifestation of the illness with very few reports in the literature in children. Case report: A 5-year-old girl with no significant medical history presented with unsteady gait ongoing for 4 days. Vitals signs and physical examination were normal. Neurological examination was remarkable for hypotonia of all the limbs, dysarthria, nystagmus, bilateral dysmetria, intention tremor and marked ataxia. Magnetic resonance imaging was normal. Cerebrospinal fluid showed a mild pleocytosis (30 cells/mm3 , all mononuclear), normal protein and glucose. Acyclovir, ceftriaxone and clarithromycin were given empirically. Serological markers for herpes simplex, cytomegalovirus, varicella zoster, mups, rubella, measles, and Epstein Barr viruses and mycoplasma were negative. Serum serologic evaluation for Borrelia burgdorferi was positive for IgM and negative for IgG antibodies on the 5th day of admission. Cerebrospinal fluid lyme serology could not be performed. Intravenous cefotaxime was given for 28 days. At the time of discharge on day 28 neurologic examination was completely normal. Both IgM and IgG antibodies for Borrelia burgdorferi were positive on day 28 and but only IgG antibodies were positive on day 120. Conclusion: Central nervous system involvement is not uncommonly seen in patients with Lyme disease. However, acute cerebellar ataxia is a rare manifestation of the illness with very few reports in the literature in children. P22.14 Acute Disseminated Encephalomyelitis associated with Influenza A (H1N1) virus 1 ¨ , F. Alehan1 , T. Yildirim2 . 1 Department of I. Erol1 *, Y. Ozkale Pediatrics, Division of Child Neurology, Baskent University Faculty of Medicine, Turkey, 2 Department of Radiology, Baskent University Faculty of Medicine, Turkey
Introduction: Acute disseminated encephalomyelitis (ADEM) is an immune-mediated inflammatory disorder of the CNS characterized by demyelination that predominantly involves the white matter of the brain and spinal cord. ADEM usually follows an infection, often of the upper respiratory tract. Herein, we describe a case of ADEM, associated with influenza A (H1N1) virus.
Poster sessions
positive. On day three of the illness she was noted to have progressively deteriorating hypotonia and mutism. There were no features of encephalopathy. Despite her inability to speak she was able to demonstrate appropriate emotional responses with preserved laughter and crying. Over the following week she developed truncal ataxia and dysmetria. Four months after the event, she has shown good recovery with normal symmetrical motor functions and coordination. She continues to have minimal speech disturbance. CSF analysis was normal with negative viral PCR. MRI brain with diffusion weighted images showed bilateral, symmetrical hyper intensity of the grey matter of both cerebellar hemispheres. There are few reported cases of cerebellitis following Rotaviral diarrhoea. Most of the cases with neurological complications following Rotaviral infection have negative CSF serology. The pathogenesis remains poorly understood in such cases. Our case demonstrates typical clinical and MRI findings of acute cerebellitis, a rare complication of a common childhood illness.
the quarter of cases. As both infectious and inflammatory mechanisms could be implicated in the AIS following VZV, antiviral and anti-inflammatory drugs could have potentially therapeutic role. Case report: We present the case of 7-year-old boy who developed slight left hemiparesis two weeks after chickenpox. Symptoms of hemiparesis gradually regressed during the first day but five days later left hemiparesis reoccurred. Brain imaging showed hypodensity in the basal ganglia which is the most common localization affected by VZV. The patient was treated with acyclovir and methylprednisolone. Short and long term prognosis has showed gradual regression of the clinical and radiological changes. Conclusion: Acute arterial ischemic stroke, especially recurrent, should be suspected as a complication of VZV infection in case of typical middle cerebral artery infarction with the changes in the basal ganglia even in the late period after VZV infection as recognition of specific aetiology can influence treatment strategy.
P22.11 EEG as a predictor of Lyme disease in a child with a peripheral facial palsy
I. Erol1 , S. Saygi1 , F. Alehan1 *. 1 Department of Pediatrics, Division of Child Neurology, Baskent University Faculty of Medicine, Turkey
P22.13 Acute cerebellar ataxia due to Lyme disease
1 ˇ M. Malenica1 *, Lj. Cvitanovic, R.G. Juraˇski1 , G. Teˇsovic´ 2 . ´ Sojat Neuropediatrics Department, University Hospital Sestre Milosrdnice, Zagreb, Croatia, 2 University Hospital for Infectious Diseases “dr.Fran Mihaljevi´c”, Zagreb, Croatia 1
Background: Although EEG changes in encephalopathies are known, diagnostic criteria for possible, probable, or definite neuroborreliosis still do not include EEG findings. Aim of the study: We suspected neuroborreliosis in a patient with peripheral facial palsy without history of a tick bite using EEG findings. Methods: Blood count and serum chemistry, serum and liquor serology, ECG, EEG, MRI of the brain, cardiology, dermatology, ophtalmology and physiatric consultation were done during the course of the disease. Results: The patient presented with peripheral facial palsy as single symptom. Brain MRI, blood count and serum chemistry showed no abnormality. EEG on day 6 demonstrated nonspecific generalized slowing, focal centrofrontal slowing, and grouped high voltage parieto-occipital bilateral slow waves, vulnerable to hyperventilation, with no epileptiform activity. We suspected Lyme disease, and with later development of erythema migrans, fever, malaise and positive serology for Borrelia burgdorferi in serum and liquor neuroborreliosis was confirmed. Serology for tick-borne encephalitis was negative. Because of the left hemiblock on ECG, ECHO was performed. The patient received 2g of ceftriaxone i.v. for 14 days. EEG findings were normalized and facial nerve function restored. Conclusion: Our patient who presented with peripheral nerve palsy and no history of tick bite had EEG changes which led us to investigate for and prove Lyme disease. Our case is a further confirmation that EEG findings could be indicative of Lyme disease. P22.12 Childhood cerebral infarction following varicella zoster virus infection N. Vaiciene-Magistris1 *, J. Grigoniene1 , P. Barkauskiene1 . 1 Lithuanian University of Health Sciences, Lithuania Introduction: Neurological complications of the common varicella zoster virus (VZV) infection are rare and include cerebellar ataxia, encephalitis, meningitis, optic neuritis, myelitis, vasculitis and very rarely arterial ischemic stroke (AIS). Clinical symptoms of stroke may occur 1 week to 12 months after varicella disease. The majority of the patients have infarction in the middle cerebral artery. The recurrent transient ischemic attacks or new infarcts occur in
Introduction: Lyme disease is an infectious disease caused by the Borrelia spirochaetes, usually transmitted to humans by the Ixodes ticks. It is manifested by a wide spectrum of clinical symptoms. Cerebellar involvement in Lyme disease is a known but rare manifestation of the illness with very few reports in the literature in children. Case report: A 5-year-old girl with no significant medical history presented with unsteady gait ongoing for 4 days. Vitals signs and physical examination were normal. Neurological examination was remarkable for hypotonia of all the limbs, dysarthria, nystagmus, bilateral dysmetria, intention tremor and marked ataxia. Magnetic resonance imaging was normal. Cerebrospinal fluid showed a mild pleocytosis (30 cells/mm3 , all mononuclear), normal protein and glucose. Acyclovir, ceftriaxone and clarithromycin were given empirically. Serological markers for herpes simplex, cytomegalovirus, varicella zoster, mups, rubella, measles, and Epstein Barr viruses and mycoplasma were negative. Serum serologic evaluation for Borrelia burgdorferi was positive for IgM and negative for IgG antibodies on the 5th day of admission. Cerebrospinal fluid lyme serology could not be performed. Intravenous cefotaxime was given for 28 days. At the time of discharge on day 28 neurologic examination was completely normal. Both IgM and IgG antibodies for Borrelia burgdorferi were positive on day 28 and but only IgG antibodies were positive on day 120. Conclusion: Central nervous system involvement is not uncommonly seen in patients with Lyme disease. However, acute cerebellar ataxia is a rare manifestation of the illness with very few reports in the literature in children. P22.14 Acute Disseminated Encephalomyelitis associated with Influenza A (H1N1) virus 1 ¨ , F. Alehan1 , T. Yildirim2 . 1 Department of I. Erol1 *, Y. Ozkale Pediatrics, Division of Child Neurology, Baskent University Faculty of Medicine, Turkey, 2 Department of Radiology, Baskent University Faculty of Medicine, Turkey
Introduction: Acute disseminated encephalomyelitis (ADEM) is an immune-mediated inflammatory disorder of the CNS characterized by demyelination that predominantly involves the white matter of the brain and spinal cord. ADEM usually follows an infection, often of the upper respiratory tract. Herein, we describe a case of ADEM, associated with influenza A (H1N1) virus.