Pediatric Neurology Cases

Topic: Pediatric Neurology Cases.

Talk By: Dr. Vrajesh Udani, Dr. Lokesh Lingappa and Dr. Soumya Sundaram.

When: Saturday, April 13, 2024, at 09:00 AM Eastern Time ( US/ Canada ).

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Dr. Vrajesh Udani, MD Consultant, Child Neurology and Epilepsy, is currently working at the Comprehensive Epilepsy Center, Section Child Neurology; PD Hinduja National Hospital, Consultant BJ Wadia Hospital for Children, Mumbai, India SRCC Children’s Hospital. He has completed his Pediatric Neurology and Clinical Neurophysiology from New York, USA, and Epilepsy from Miami, USA. His special interests in neurology are Complex Epilepsy, Medical and Surgical Management, Perinatal Brain Injury, and Autoimmune Neurological Disorders. Dr. Udani has been the Past President of AOCN 2016-2018; Past Chairperson of Pediatric Neurology Subsection, Indian Academy of Neurology 2023-present; President of Child Neurology Group, Mumbai; Organising Chairperson of ICNC Mumbai 2018; Member of the Executive Board of ICNA 2022 – present.

Pediatric Neurology Case 1: Red Herrings Galore

This is an ordinary young 8-year-old boy who started with a single seizure, which was initially diagnosed as Tumefactive Demyelination, and, over the next three months, progressed with focal deficits, cranial nerve palsies, and progressive encephalopathy. He was extensively investigated and treated with different modalities to no avail. Several diagnoses were "proven" only to be discarded at a later date. The final diagnosis was an unusual infection, which will be elaborated on.

Learning Objectives are- 

• Acquired Demyelination has several unusual etiologies. All are not immune-mediated.
• Minor details in the past medical history may give a clue as to the actual diagnosis.
• A review of pathological material should be asked for when diseases do not follow an expected course.

Dr. Soumya Sundaram is an MD (Medicine), DM (Neurology), and ICMR-DHR International Fellowship in Autism Spectrum Disorders. She is an Additional Professor in Charge of Pediatric Neurology and Neurodevelopmental Disorders in the Department of Neurology at Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India. She is also a Panel Member in the collaborative network in Autism Spectrum Disorders by the Department of Biotechnology, India, and a Section Editor of Neurology India.

Pediatric Neurology Case 2: A Twist In The Tale Of Three Siblings

Three siblings, who were born of second-degree consanguineous marriage, presented to our hospital with a global developmental delay. The proband was a 9-year-old girl, and her antenatal, natal, and post-natal periods were uneventful. She had a global developmental delay—neck control attained by two years of age, sitting with support by three years, and she was unable to walk. She started speaking bisyllables by three years of age but was unable to tell sentences.

Learning Objectives are- 

• In challenging childhood-onset movement disorders, focused history and clinical examination can provide the answers.
• A judicious selection of investigations is apt in resource-constrained settings.
• Treatable causes should never be missed and levodopa trials should be administered in suspected metabolic or genetic dystonia.
• Dopamine replacement therapy may improve the motor manifestations in neurotransmitter disorders, but residual cognitive and language deficits often persist.

Dr. Lokesh Lingappa is the Clinical Lead of the Division of Pediatric Neurosciences Consultant Child and Adolescent Neurologist Rainbow Children’s Hospital, Hyderabad, India. He has completed his MD Pediatrics, PGIMER, and DM Neurology NIMHANS from Bengaluru, India; MRCPCH from the UK; and he has been a Fellow in Pediatrics Neurology in Bristol, UK. Dr. Lokesh's areas of interest are Critical Care Neurology, Stroke, and One of three centers for DrNB Ped Neurology.

Pediatric Neurology Case 3: 4year old with short stature, abnormal movements and loss of speech

4 A 4-year-old child presented to the pediatrician with a history of abnormal facial movements while awake for one week prior to presentation. Her electrolytes, calcium, and magnesium levels were normal. EEG was reported to be normal. MRI of the brain demonstrated a pituitary lesion, enhancing contrast. At first evaluation in outpatient, she was noted to have slow responses, proportionate short stature, and movements of the face suggestive of likely motor tics/focal without impaired awareness seizures. She was evaluated for short stature and pituitary lesion. Significant hypothyroidism with low T3, T4, and high TSH were noted. She was started on thyroid supplements and sent after sending thyroid antibodies. After five days, the child started having difficulty walking and, later, two episodes of focal seizures and loss of speech. She was admitted and treated with Methylprednisolone as her antithyroid antibodies were elevated- considering Steroid responsive encephalopathy associated with hypothyroidism. As the mutism was persistent, Lumbar puncture was done, which was normal cell count and protein and sugar. She had started improving and was discharged on maintenance steroids. An autoimmune panel was sent across.

Learning Objectives are- 

• Discuss the differences in paroxysmal movements involving the face.
• Ethologies of the pituitary lesion in children.
• Encephalopathy associated with hypothyroidism.
• Role of thyroid antibodies in encephalopathy.

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