A six-year-old boy was presented with the diagnosis of left-sided hemiparesis and facial nerve paralysis. The findings showed multiple well-defined focal lesions bilaterally in the right, parietal region and the child was being treated with methylprednisolone followed by oral prednisolone. This was followed by several relapses, including recurrent episodes of limb weakness and facial nerve paralysis. MRI brain and spinal cord revealed multiple new hyperintense T2 white matter lesions. According to latest relapse observed in right side hemiparesis, the patient had visual impairment, difficulty in walking and swallowing for three weeks along with fever and high inflammatory markers.
Results
Ans (C): Multiple Sclerosis
The initial episode of multiple sclerosis can present as an isolated monophasic illness in may pediatric patients. The clinical evolution of multiple sclerosis are marked by the presence of oligoclonal bands in cerebrospinal fluid, periventricular lesions, hypointense lesions on T1, lesions of the corpus callosum and past Epstein Barr viral infection. The diagnosis can be challenging as the child presented with hemiparesis or paraparesis, visual disturbance and ataxia, demanding the differential diagnosis of multiple sclerosis from acute demyelinating encephalomyelitis and neuromyelitis optica. Changes in the MRIs demonstrated multifocal, diffuse, and hyperintense T2 white matter lesions. However, as the patient lacked any clear infectious cause and demonstrated recurrent demyelination, multiple sclerosis was the most clinically relevant diagnosis.
