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Combined Striatum, Brain Stem, and Optic Nerve Involvement due to Mycoplasma pneumoniae in an Ambulatory Child.

Bae JW, Kim HJ, Chang GY, Kim EJ - Case Rep Neurol (2011)

Bottom Line: In children, Mycoplasma pneumoniae encephalitis has been characterized by acute onset of an encephalopathy associated with extrapyramidal symptoms and symmetric basal ganglia with or without brain stem involvement on magnetic resonance imaging.Our case, showing unilateral optic neuritis, ophthalmoplegia, no extrapyramidal symptoms, and typical striatal involvement on magnetic resonance imaging, broadens the spectrum of varying clinical manifestations of childhood M. pneumoniae-associated encephalopathy.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Korea.

ABSTRACT
In children, Mycoplasma pneumoniae encephalitis has been characterized by acute onset of an encephalopathy associated with extrapyramidal symptoms and symmetric basal ganglia with or without brain stem involvement on magnetic resonance imaging. Our case, showing unilateral optic neuritis, ophthalmoplegia, no extrapyramidal symptoms, and typical striatal involvement on magnetic resonance imaging, broadens the spectrum of varying clinical manifestations of childhood M. pneumoniae-associated encephalopathy.

No MeSH data available.


Related in: MedlinePlus

a Initial axial FLAIR images demonstrate marked high-signal intensity in the right cerebellum, brain stem, left optic nerve (arrow), bilateral basal ganglia and thalamus. b Follow-up FLAIR images at 2 weeks after treatment show decreased high-signal intensities compared to those of the previous images.
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Figure 1: a Initial axial FLAIR images demonstrate marked high-signal intensity in the right cerebellum, brain stem, left optic nerve (arrow), bilateral basal ganglia and thalamus. b Follow-up FLAIR images at 2 weeks after treatment show decreased high-signal intensities compared to those of the previous images.

Mentions: A previously healthy 7-year-old boy was admitted complaining of blurry vision for 4 days. He had been diagnosed with M. pneumoniae 2 weeks before and had been recovering at home. His mother noted that over the course of 2 days, the boy took more naps than usual but remained playful despite visual complaints. She observed no difficulty with his ambulation. He denied any headache or eye pain. Neurological examination revealed an alert, responsive child with left abducens nerve palsy. His left visual acuity was limited to light perception. The right pupil was briskly reactive but the left was sluggish with afferent pupillary defect. Funduscopic examination confirmed a left swollen optic disc. He walked normally but complained of not seeing clearly. Laboratory examination was remarkable for elevated cold agglutinin of 1:32 and positive M. pneumoniae antibody titer of 1:2,560. Serum toxoplasma-specific IgM antibody, cytomegalovirus-specific IgM antibody, Rubella-specific IgM antibody, herpes simplex virus-specific IgM antibody and lactate levels were all negative or normal. Cerebrospinal fluid was normal with 0 white blood cells/dl, glucose of 56 mg/dl, and protein of 37 mg/dl. Oligoclonal banding was absent. MRI, on T2-weighted and FLAIR images, showed symmetric high-signal lesions over the putamen, pallidium, thalamus, and brain stem tegmentum near the floor of the 4th ventricle, but the subcortical white matter was spared (fig. 1a). A bright signal on the left optic nerve (fig. 1a, arrow) and a single right cerebellar white matter lesion were also detected. No abnormal signal change was seen on diffusion-weighted images. After starting intravenous methylprednisolone, his left visual acuity improved from light perception to finger count and abducens nerve palsy resolved over a 2-week period. Two weeks later, follow-up MRI showed improvement in attenuation of signal intensities (fig. 1b).


Combined Striatum, Brain Stem, and Optic Nerve Involvement due to Mycoplasma pneumoniae in an Ambulatory Child.

Bae JW, Kim HJ, Chang GY, Kim EJ - Case Rep Neurol (2011)

a Initial axial FLAIR images demonstrate marked high-signal intensity in the right cerebellum, brain stem, left optic nerve (arrow), bilateral basal ganglia and thalamus. b Follow-up FLAIR images at 2 weeks after treatment show decreased high-signal intensities compared to those of the previous images.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3104858&req=5

Figure 1: a Initial axial FLAIR images demonstrate marked high-signal intensity in the right cerebellum, brain stem, left optic nerve (arrow), bilateral basal ganglia and thalamus. b Follow-up FLAIR images at 2 weeks after treatment show decreased high-signal intensities compared to those of the previous images.
Mentions: A previously healthy 7-year-old boy was admitted complaining of blurry vision for 4 days. He had been diagnosed with M. pneumoniae 2 weeks before and had been recovering at home. His mother noted that over the course of 2 days, the boy took more naps than usual but remained playful despite visual complaints. She observed no difficulty with his ambulation. He denied any headache or eye pain. Neurological examination revealed an alert, responsive child with left abducens nerve palsy. His left visual acuity was limited to light perception. The right pupil was briskly reactive but the left was sluggish with afferent pupillary defect. Funduscopic examination confirmed a left swollen optic disc. He walked normally but complained of not seeing clearly. Laboratory examination was remarkable for elevated cold agglutinin of 1:32 and positive M. pneumoniae antibody titer of 1:2,560. Serum toxoplasma-specific IgM antibody, cytomegalovirus-specific IgM antibody, Rubella-specific IgM antibody, herpes simplex virus-specific IgM antibody and lactate levels were all negative or normal. Cerebrospinal fluid was normal with 0 white blood cells/dl, glucose of 56 mg/dl, and protein of 37 mg/dl. Oligoclonal banding was absent. MRI, on T2-weighted and FLAIR images, showed symmetric high-signal lesions over the putamen, pallidium, thalamus, and brain stem tegmentum near the floor of the 4th ventricle, but the subcortical white matter was spared (fig. 1a). A bright signal on the left optic nerve (fig. 1a, arrow) and a single right cerebellar white matter lesion were also detected. No abnormal signal change was seen on diffusion-weighted images. After starting intravenous methylprednisolone, his left visual acuity improved from light perception to finger count and abducens nerve palsy resolved over a 2-week period. Two weeks later, follow-up MRI showed improvement in attenuation of signal intensities (fig. 1b).

Bottom Line: In children, Mycoplasma pneumoniae encephalitis has been characterized by acute onset of an encephalopathy associated with extrapyramidal symptoms and symmetric basal ganglia with or without brain stem involvement on magnetic resonance imaging.Our case, showing unilateral optic neuritis, ophthalmoplegia, no extrapyramidal symptoms, and typical striatal involvement on magnetic resonance imaging, broadens the spectrum of varying clinical manifestations of childhood M. pneumoniae-associated encephalopathy.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Korea.

ABSTRACT
In children, Mycoplasma pneumoniae encephalitis has been characterized by acute onset of an encephalopathy associated with extrapyramidal symptoms and symmetric basal ganglia with or without brain stem involvement on magnetic resonance imaging. Our case, showing unilateral optic neuritis, ophthalmoplegia, no extrapyramidal symptoms, and typical striatal involvement on magnetic resonance imaging, broadens the spectrum of varying clinical manifestations of childhood M. pneumoniae-associated encephalopathy.

No MeSH data available.


Related in: MedlinePlus