Blepharoptosis and dysarthria in a boy aged 2 years

ZHAO Li-Rong, ZHAO Jing-Jing, FU Zhuo, FU Jun-Xian, WANG Ting, YANG Xiao-Guang, YANG Guang-Lu

Chinese Journal of Contemporary Pediatrics ›› 2020, Vol. 22 ›› Issue (12) : 1320-1325.

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Chinese Journal of Contemporary Pediatrics ›› 2020, Vol. 22 ›› Issue (12) : 1320-1325. DOI: 10.7499/j.issn.1008-8830.2007142
COMPLICATED CASE STUDY

Blepharoptosis and dysarthria in a boy aged 2 years

  • ZHAO Li-Rong1, ZHAO Jing-Jing2, FU Zhuo2, FU Jun-Xian2, WANG Ting2, YANG Xiao-Guang3, YANG Guang-Lu2
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Abstract

A boy, aged 2 years and 4 months, had a sudden onset of blepharoptosis of the right eyelid, accompanied by the mouth deviated to the right side, drinking cough, nystagmus, and developmental regression. Cranial MRI showed softening lesions formed after infarction of the right dorsolateral medulla oblongata, while head CT angiography showed no imaging of the proximal part of the V4 segment of the right vertebral artery. The child was diagnosed with dorsolateral medulla oblongata syndrome and was treated with gamma globulin to regulate immune function, with mannitol to reduce neuronal edema, with low-molecular-weight heparin sodium to improve local hypercoagulation of occluded blood vessels, with hyperbaric oxygen to improve local ischemia and hypoxia and promote the recovery of brain function, and with neuromuscular electrical stimulation to promote the recovery of neuromuscular function. Before discharge, only mild right ataxia and Horner syndrome remained. This article reports the first case of infantile dorsolateral medulla oblongata syndrome and provides experience for the diagnosis and treatment of the disease.

Key words

Wallenberg syndrome / Diagnosis / Prognosis / Child

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ZHAO Li-Rong, ZHAO Jing-Jing, FU Zhuo, FU Jun-Xian, WANG Ting, YANG Xiao-Guang, YANG Guang-Lu. Blepharoptosis and dysarthria in a boy aged 2 years[J]. Chinese Journal of Contemporary Pediatrics. 2020, 22(12): 1320-1325 https://doi.org/10.7499/j.issn.1008-8830.2007142

References

[1] Wallenberg A. Acute Bulbäraffection (Embolie der Art. cerebellar. post. inf. sinistr.?)[J]. Arch Psychiatr Nervenkr, 1895, 27(2):504-540.
[2] Day GS, Swartz RH, Chenkin J, et al. Lateral medullary syndrome:a diagnostic approach illustrated through case presentation and literature review[J]. CJEM, 2014, 16(2):164-170.
[3] Louis DW, Dholakia N, Raymond MJ. Wallenberg syndrome with associated motor weakness in a two-week-postpartum female[J]. Case Rep Neurol, 2015, 7(3):186-190.
[4] Lagman-Bartolome AM, Pontigon AM, Moharir M, et al. Basilar artery strokes in children:good outcomes with conservative medical treatment[J]. Dev Med Child Neurol, 2013, 55(5):434-439.
[5] 庞艳, 刘英坤. 延髓背外侧综合征误诊3例报告[J]. 吉林医学, 2009, 30(14):1494.
[6] Aihara M, Naito I, Shimizu T, et al. Predictive factors of medullary infarction after endovascular internal trapping using coils for vertebral artery dissecting aneurysms[J]. J Neurosurg, 2018, 129(1):107-113.
[7] Kim JS. Pure lateral medullary infarction:clinical-radiological correlation of 130 acute, consecutive patients[J]. Brain, 2003, 126(Pt 8):1864-1872.
[8] 王建, 段丹, 王庆松, 等. Wallenberg综合征患者椎动脉发育不良现象相关临床研究[J]. 中风与神经疾病杂志, 2014, 31(9):826-829.
[9] Lee SU, Park SH, Park JJ, et al. Dorsal medullary infarction:distinct syndrome of isolated central vestibulopathy[J]. Stroke, 2015, 46(11):3081-3087.
[10] 胡杰, 许瑞卿, 吕祥龙, 等. 延髓背外侧综合征临床分析[J]. 中国现代神经疾病杂志, 2019, 19(1):41-46.
[11] Kim JS, Lee JH, Suh DC, et al. Spectrum of lateral medullary syndrome. Correlation between clinical findings and magnetic resonance imaging in 33 subjects[J]. Stroke, 1994, 25(7):1405-1410.
[12] Barrett RT, Bao X, Miselis RR, et al. Brain stem localization of rodent esophageal premotor neurons revealed by transneuronal passage of pseudorabies virus[J]. Gastroenterology, 1994, 107(3):728-737.
[13] Aydogdu I, Ertekin C, Tarlaci S, et al. Dysphagia in lateral medullary infarction (Wallenberg's syndrome):an acute disconnection syndrome in premotor neurons related to swallowing activity?[J]. Stroke, 2001, 32(9):2081-2087.
[14] Kato S, Takikawa M, Ishihara S, et al. Pathologic reappraisal of Wallenberg syndrome:a pathologic distribution study and analysis of literature[J]. Yonago Acta Med, 2014, 57(1):1-14.
[15] Wu S, Li N, Xia F, et al. Neurotrophic keratopathy due to dorsolateral medullary infarction (Wallenberg syndrome):case report and literature review[J]. BMC Neurol, 2014, 14:231.
[16] De Bruyn D, Van Aken E, Herman K. A rare case of concomitant sicca keratopathy and ipsilateral central facial palsy in Wallenberg's dorsolateral medullary syndrome[J]. GMS Ophthalmol Cases, 2017, 7:Doc08.
[17] 宗寿健, 胡晓洁, 孙贵芝, 等. 变异型延髓背外侧综合征1例[J]. 现代医药卫生, 2019, 35(16):2589-2591.
[18] 孙庆华, 徐林麟, 尹琳. 延髓梗死的临床与神经影像学分析(附73例报告)[J]. 中风与神经疾病杂志, 2016, 33(10):923-926.
[19] Ross MA, Biller J, Adams HP Jr, et al. Magnetic resonance imaging in Wallenberg's lateral medullary syndrome[J]. Stroke, 1986, 17(3):542-545.
[20] 黄妍, 张军, 王洁, 等. 经颅磁治疗对延髓背外侧综合征患者吞咽构音功能及生存质量的影响[J]. 中风与神经疾病杂志, 2020, 37(1):49-54.

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