Bumbling, Stumbling, Fumbling: Weakness, Steppage Gait, and Facial Droop in a 3-Year-Old Male

Global Pediatric Health
Aviva J WhelanShane C Rainey

Abstract

A previously healthy, unimmunized, 3-year-old Caucasian boy presented to the emergency department with right-sided facial droop, clumsiness, and intermittent bilateral hip pain. Two weeks ago, he had 24 hours of self-resolving rhinorrhea and fever. Examination was significant for right facial nerve palsy, lower extremity pain, areflexia of his right lower extremity, and diminished reflexes of his left lower extremity. He was admitted for urgent magnetic resonance imaging of the brain. Cerebrospinal fluid (CSF) protein was 85 mg/dL with elevated albumin and immunoglobulin, and CSF white blood cell was 3 cells/mm3. Serum Mycoplasma immunoglobulin (Ig) M and IgG were elevated. There was concern for Guillain-Barré syndrome (GBS). He was started on intravenous IG (IVIG) and was treated for presumed Mycoplasma infection. Weakness and gait disturbances in a child can present the clinician with a diagnostic challenge. Gait disturbance may indicate a neurological lesion anywhere from the central nervous system to the peripheral nerves, neuromuscular junction, or muscle. In the present case, the combination of peripheral facial palsy, presumed neuropathic pain, gait difficulties, and areflexia in the setting of an antecedent respiratory ...Continue Reading

References

Apr 23, 1992·The New England Journal of Medicine·A H Ropper
Jan 1, 1990·Annals of Neurology·A K Asbury, D R Cornblath
Mar 1, 1993·Critical Care Medicine·E F HundG M McKhann
Jan 1, 1995·Scandinavian Journal of Infectious Diseases·N GürsesA G Kalayci
Apr 1, 1996·Archives of Disease in Childhood·R Korinthenberg, J S Mönting
Jan 1, 1997·Pediatrics in Review·O B Evans, V Vedanarayanan
Sep 24, 1998·Lancet·A F Hahn
Mar 29, 2001·Neurology·R D HaddenUNKNOWN Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group
Nov 23, 2007·Archives of Disease in Childhood. Education and Practice Edition·S AgrawalW P Whitehouse
Apr 17, 2010·Journal of Clinical Immunology·Pieter A van DoornBart C Jacobs
Jan 26, 2011·Journal of Health, Population, and Nutrition·Kate O PoropatichRobert E Black
Mar 2, 2011·Neurology·J RoodbolB C Jacobs
Jun 15, 2012·The New England Journal of Medicine·Nobuhiro Yuki, Hans-Peter Hartung
Oct 23, 2012·Pediatrics and Neonatology·Mei-Hua HuChang-Teng Wu
Feb 28, 2017·The Cochrane Database of Systematic Reviews·Sylvie ChevretDjillali Annane

❮ Previous
Next ❯

Related Concepts

Related Feeds

CSF & Lymphatic System

This feed focuses on Cerebral Spinal Fluid (CSF) and the lymphatic system. Discover the latest papers using imaging techniques to track CSF outflow into the lymphatic system in animal models.