Latuska Richard F, Otillio Jaime K
From the Department of Pediatric Emergency Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN.
Pediatr Emerg Care. 2020 Mar;36(3):e172-e174. doi: 10.1097/PEC.0000000000002054.
In this case report, we describe a unique case of Haemophilus influenzae type A meningitis in a 7-month-old previously healthy girl that presented with an isolated cranial nerve (oculomotor) palsy without other signs and symptoms classically associated with this entity such as fever, meningismus, or a generally ill appearance. Oculomotor nerve abnormalities are rare in pediatrics. Congenital oculomotor palsy is the most common cause followed by trauma, infection, inflammatory conditions, neoplasm, aneurysm or other vascular events, and ophthalmoplegic migraines, respectively. Therefore, had it not been for the unusual magnetic resonance imaging findings identified in this patient prompting an extensive infectious workup with lumbar puncture, the diagnosis and treatment of meningitis may have been delayed further or missed all together. This fact emphasizes the importance of maintaining a broad differential when children present with neurologic abnormalities such as cranial nerve palsies.
在本病例报告中，我们描述了一名7个月大、此前健康的女孩患甲型流感嗜血杆菌脑膜炎的独特病例，该病例表现为孤立的颅神经（动眼神经）麻痹，无其他与该疾病典型相关的体征和症状，如发热、颈项强直或一般病态面容。动眼神经异常在儿科中较为罕见。先天性动眼神经麻痹是最常见的原因，其次分别是外伤、感染、炎症性疾病、肿瘤、动脉瘤或其他血管事件以及眼肌麻痹性偏头痛。因此，如果不是该患者磁共振成像检查发现的异常表现促使进行包括腰椎穿刺在内的广泛感染性检查，脑膜炎的诊断和治疗可能会进一步延迟或完全漏诊。这一事实强调了在儿童出现如颅神经麻痹等神经异常时保持广泛鉴别诊断的重要性。
