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1351 Unusual differential for generalised weakness in a 10 month child

Singh, Ajeet Pratap ; Johnson, Hugh ; Khanna, Neha

Archives of disease in childhood, 2021-10, Vol.106 (Suppl 1), p.A333-A333 [Periódico revisado por pares]

London: BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health

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  • Título:
    1351 Unusual differential for generalised weakness in a 10 month child
  • Autor: Singh, Ajeet Pratap ; Johnson, Hugh ; Khanna, Neha
  • Assuntos: Abstracts ; Adrenal glands ; Biopsy ; Children ; Compression ; Differential diagnosis ; Emergency medical care ; Magnetic resonance imaging ; Myelitis ; Neonates ; Neuroblastoma ; Neuroimaging ; Paralysis ; Pediatrics ; Peritoneum ; Pregnancy ; Primary care ; Reflexes ; Scientific Concepts ; Spinal cord ; Sympathetic ganglia ; Thorax ; Tumors
  • É parte de: Archives of disease in childhood, 2021-10, Vol.106 (Suppl 1), p.A333-A333
  • Notas: British Paediatric Neurology Association
    Royal College of Paediatrics and Child Health, Abstracts of the RCPCH Conference–Online, 15 June 2021–17 June 2021
  • Descrição: BackgroundA ten month old girl was referred to the Emergency department by her primary care physician with complaints of progressive generalised weakness. Parents started noticing significant weakness in both lower limbs with painful cries when pulled to sit and during nappy changes. She was born by IVF pregnancy at 32 weeks gestation and had an uneventful neonatal course. There were no concerns with regards to development and at age of ten months, she was able to Crawl/weight bear/stand prior to these new onset symptoms.When examined, she was lying supine on a flat bed with noticeably reduced lower limb movements. Detailed neurological evaluation confirmed bilateral lower limb lower motor neuron type flaccid paralysis and absent reflexes. In view of rapid deterioration, Guillain Barre syndrome and transverse myelitis were the top differential diagnosis as she had no obvious sources or signs of infection. The child underwent necessary bloods and imaging of brain and spine as an inpatient. MRI spine revealed a solid extradural mass at level of L1– L3 reported as suspected nerve sheath tumour, likely shwannoma. She was transferred to a tertiary oncology unit where a diagnosis of adrenal neuroblastoma with spinal extension/compression was made in conjunction after biopsy and repeat MRI reports.BackgroundNeuroblastoma is the most common solid extradural tumor in children with 40% of the cases diagnosed under the age of one year. The adrenal gland is the most common primary site, followed by abdominal, thoracic, cervical and pelvic sympathetic ganglia. Primary tumours, usually in the retro peritoneum are able to invade the spinal canal through the neural foramina, creating a so-called ‘dumbbell’ tumor . The subsequent epidural spinal cord compression, an oncologic emergency, can cause pain, motor or sensory deficits, or loss of bowel and/or bladder control. The subtle and gradual onset of such neurologic symptoms in young children can make diagnosis difficult.ObjectivesNot Required ( case report )MethodsNot Required ( case report )ResultsNot Required ( case report )ConclusionsLearning/conclusion :Although not a very rare presentation for retroperitoneal (adrenal) neuroblastoma, but this was definitely a surprising and unexpected finding for a child presenting with predominantly lower limb weakness. On reflection, it could have been disastrous for the child and the family if left unnoticed or misdiagnosed. Every child should have a complete examination irrespective of presentation or magnitude of illness or complaint. All necessary imaging should be performed prior to more invasive investigations.
  • Editor: London: BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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