| Autor: |
Marques, Izabela Cristina Macedo, Silva Junior, Rui Carlos, Silva, Giulia Vilela, de Araújo Júnior, Nildo Vilacorte, do Valle, Daniel Almeida, Zeny, Michelle Silva, Spinosa, Monica Jaques, Auerswald, Elisabete Coelho Coelho, Lohr, Alfredo |
| Zdroj: |
Arquivos de Neuro-Psiquiatria; 2023 Supplement 1, Vol. 81, p210-210, 1p |
| Abstrakt: |
Case presentation: Three-year-old male admitted with aphasia and mental confusion that last 48 hours. Report a fever peak of 38°C. Vomiting and hyaline rhinorrhea resolved four days ago. Plus diarrheal symptoms three weeks prior to hospitalization. He did not recognize his mother and other family members, he was frightened by environmental stimuli, he could not walk, he fell if placed standing and did not sit without support. Previously healthy. History of febrile seizures at 1 year of age on sodium valproate. Proper motor development, but with speech delay. Son of a healthy couple non-consanguineous from Manaus, attended day care with good socialization. On examination he was awake but disoriented, cranial nerves unaltered. He presented traction of the lower limbs with flexion of the thigh to painful stimuli and spontaneous elevation of the lower limbs against gravity, without signs of pyramidal release with bilateral patellar areflexia. Lumbar puncture showed cellularity of 27 and predominance of lymphocytes, protein 19, glucose 51and lactate 1.4. Normal metabolic tests and cranial tomography. Started acyclovir and requested panel for viral meningitis in the cerebrospinal fluid (CSF). The following day, he progressed with worsening, dysphagia and loss of head support, he maintained the lower limb areflexia, being referred to the ICU where he received immunoglobulin. He was discharged from the ICU after 48 hours with improvement. Ophthalmologic evaluation and EEG were normal. Neuroaxis MRI showed bilateral and symmetrical signal alteration in the posterior region of the brainstem, more evident in the bulb pontine region with insinuation to the dentate nucleus of the cerebellar hemispheres, without anomalous contrast impregnation, suggesting viral or autoimmune etiology. Therefore, it was chosen to repeat the lumbar puncture with normal CSF (4 cells). The patient evolved with recovery of consciousness and neurotendinous reflexes. The CSF panel showed positive PCR for adenovirus. The patient was discharged asymptomatic, and acyclovir was discontinued. Discussion: Adenovirus infection is a rare cause of viral meningoencephalitis. Involvement ranges from reversible meningitis to fatal necrotizing encephalopathy. Final comments: Isolation of the agent in CSF or other body fluids is essential and avoids unnecessary treatments and tests as well as favors the possibility of specific antiviral therapy. [ABSTRACT FROM AUTHOR] |
| Databáze: |
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