A clinical case of acute polyneuropathy, with the onset of bilateral facial nerve palsy in an early childhood

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Abstract

BACKGROUND: The differential diagnosis of peripheral nervous system damage depends on a thorough collection of history, comprehensive assessment of clinical manifestations, and dynamic examination of the patient. This article describes a clinical case of acute polyneuropathy in a young child, which began with gastrointestinal symptoms and bilateral facial neuropathy.

CLINICAL CASE DESCRIPTION: The article presents a case of a child with an atypical course of acute polyneuropathy, which began with bilateral facial neuropathy combined with gastrointestinal complaints and pain syndrome. Features of the clinical presentation of the disease required extended laboratory and instrumental testing. Protocols for instrumental verification of diagnosis included nerve conduction studies examining neural conduction and axonal excitability of the affected facial nerve and the healthy side. Additionally, the functional status of the peripheral nerves in the upper and lower limbs was assessed. Polyneuropathic alterations revealed through nerve conduction studies confirmed diagnostic lumbar puncture to determine the presence of neuroinfectious processes. Magnetic resonance imaging of the brain, brachial, and lumbosacral plexuses using intravenous contrast showed the nature and prevalence of a lesion. Based on the overall clinical, laboratory, and instrumental examination data of the patient, “acute inflammatory demyelinating polyneuropathy” was diagnosed; timely etiopathogenetic treatment was initiated.

CONCLUSION: In children, the course of a neuroinfection may be atypical. Sometimes, when dissociating the clinical manifestations of the disease from the results of a standard laboratory and instrumental test, expert diagnostic techniques should be used for differential diagnosis purposes.

About the authors

Elena Yu. Skripchenko

Pediatric Research and Clinical Center for Infectious Diseases; Saint Petersburg State Pediatric Medical University

Author for correspondence.
Email: wwave@yandex.ru
ORCID iD: 0000-0002-8789-4750
SPIN-code: 9405-2930

MD, PhD, Associate Professor

Russian Federation, Saint Petersburg; Saint Petersburg

Maria A. Irikova

Pediatric Research and Clinical Center for Infectious Diseases

Email: dr.bedova@yandex.ru
ORCID iD: 0000-0001-8924-5300
SPIN-code: 9667-3210

MD, PhD

Russian Federation, Saint Petersburg

Vladislav B. Voitenkov

Pediatric Research and Clinical Center for Infectious Diseases; Academy of Postgraduate Education — Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies

Email: vlad203@inbox.ru
ORCID iD: 0000-0003-0448-7402
SPIN-code: 6190-6930

MD, PhD

Russian Federation, Saint Petersburg; Moscow

Natalia V. Skripchenko

Pediatric Research and Clinical Center for Infectious Diseases; Saint Petersburg State Pediatric Medical University

Email: snv@niidi.ru
ORCID iD: 0000-0001-8927-3176
SPIN-code: 7980-4060

MD, PhD, Professor

Russian Federation, Saint Petersburg; Saint Petersburg

Dmitry Yu. Novokshonov

Pediatric Research and Clinical Center for Infectious Diseases

Email: dunov7@yandex.ru
ORCID iD: 0000-0002-8228-518X
SPIN-code: 6716-4945
Russian Federation, Saint Petersburg

Natalia V. Marchenko

Pediatric Research and Clinical Center for Infectious Diseases

Email: gmv2006@mail.ru
ORCID iD: 0000-0002-2684-9980
SPIN-code: 9813-1529

MD, PhD

Russian Federation, Saint Petersburg

Ekaterina M. Vishnevetskaya

Pediatric Research and Clinical Center for Infectious Diseases

Email: yekat.mazaeva@yandex.ru
ORCID iD: 0000-0002-1432-2452
SPIN-code: 5748-6114

MD, PhD

Russian Federation, Saint Petersburg

Galina P. Ivanova

Pediatric Research and Clinical Center for Infectious Diseases

Email: ivanovagp@yandex.ru
ORCID iD: 0000-0003-1496-8576
SPIN-code: 5096-6322

MD, PhD

Russian Federation, Saint Petersburg

Ksenia V. Markova

Pediatric Research and Clinical Center for Infectious Diseases

Email: ksenija-sidorova@mail.ru
ORCID iD: 0000-0001-8652-8997
SPIN-code: 1743-6881

MD, PhD

Russian Federation, Saint Petersburg

Anna V. Astapova

Pediatric Research and Clinical Center for Infectious Diseases

Email: anna-syrovcev@mail.ru
ORCID iD: 0000-0003-4153-4319
SPIN-code: 9766-2343

MD, PhD

Russian Federation, Saint Petersburg

Andrey V. Klimkin

Pediatric Research and Clinical Center for Infectious Diseases

Email: klinkinpark@mail.ru
ORCID iD: 0000-0002-6180-4403
SPIN-code: 6309-3260

MD, PhD

Russian Federation, Saint Petersburg

Alina V. Golubeva

Pediatric Research and Clinical Center for Infectious Diseases

Email: golubeva-alinka@mail.ru
ORCID iD: 0009-0001-3449-3080
SPIN-code: 5579-8344
Russian Federation, Saint Petersburg

Polina S. Verbenko

Saint Petersburg State Pediatric Medical University

Email: lotospoliv@mail.ru
ORCID iD: 0000-0003-2128-0737
SPIN-code: 3792-2450
Russian Federation, Saint Petersburg

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2. Fig. 1. Magnetic resonance imaging of the brain, brachial and lumbosacral plexuses with intravenous contrast. MR-signs of increased accumulation of contrast agent: а — facial nerves at the level of the internal auditory canal on both sides; б — trigeminal nerves in the cisternal sections on both sides; в — brachial plexuses; г — lumbar and sacral plexuses

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