Wraige Elizabeth, Graham John, Robb Stephanie A, Jan Wajanat
Department of Paediatric Neurology, Guy's and St Thomas' Trust, London, England.
J Child Neurol. 2003 Apr;18(4):298-300. doi: 10.1177/08830738030180040501.
The differential diagnosis of acute focal neurologic deficit in childhood is diverse. We report the case of a child presenting with an acute hemiparesis persisting for longer than 24 hours following a focal seizure. The clinical history, examination findings, and results of cranial magnetic resonance imaging (MRI) were initially interpreted as consistent with an arterial ischemic cerebral infarction. Follow-up cranial MRI performed 9 months later revealed changes indicative of neurocysticercosis. Review of original neuroimaging resulted in a revision of the diagnosis to neurocysticercosis. The clinical history, together with neuroimaging findings, is highly compatible with a diagnosis of neurocysticercosis but unusual because it occurred in a child resident in a nonendemic area who had never traveled to an endemic area and whose diet excluded pork. The case reported raises two important issues. The first is the need to carefully consider the differential diagnosis of acute hemiparesis, including unusual causes. Second, it raises awareness of the potential for neurocysticercosis to occur in low-risk patients in nonendemic areas.
儿童急性局灶性神经功能缺损的鉴别诊断多种多样。我们报告一例患儿，在局灶性癫痫发作后出现持续超过24小时的急性偏瘫。最初，临床病史、检查结果及头颅磁共振成像（MRI）结果被解释为与动脉缺血性脑梗死相符。9个月后进行的随访头颅MRI显示出提示神经囊尾蚴病的改变。对原始神经影像学检查结果的复查导致诊断修正为神经囊尾蚴病。该临床病史连同神经影像学检查结果，与神经囊尾蚴病的诊断高度相符，但不同寻常的是，它发生在一名居住于非流行区、从未前往过流行区且饮食中不包含猪肉的儿童身上。所报告的该病例引发了两个重要问题。第一个问题是需要仔细考虑急性偏瘫的鉴别诊断，包括不常见的病因。第二个问题是提高了对非流行区低风险患者发生神经囊尾蚴病可能性的认识。
