Mueen Habashneh, Khaled Dahiyat.
Devic`s disease in a young Jordanian Child.
Pak Armed Forces Med J Jan ;52(2):225-6.

A 6-1/2 Years old Jordanian female child, previously healthy, presented with one-week history of right lower limb weakness alongwith urinary incontinence. Her history dates back to one month prior to presentation, when she was admitted to a peripheral hospital in the North of Jordan with clinical picture of viral meningitis, for which she was treated symptomatically, with good improvement. It was not until one week following discharge from hospital, when she developed bilateral painful parotid swelling associated with low grade fever, and a diagnosis of mumps was made, and was treated symptomatically. Following the clinical appearance of mumps, she was noticed by her parents to drag her right foot, that was associated with urinary incontinence. A brain CT scan was carried out and was reported as normal. Family, and past medical history were irrelevant. There was no history of visual problems, or loss of consciousness. General medical examination was unremarkable, and she was afebrile. Neurological examination showed intact higher cerebral functions, cranial nerves were normal except for swollen optic disc on the right side. With right relative afferent papillary defect. Light reflex and fundoscopy on the left side were normal. There was evidence of asymmetrical pyramidal weakness in both lower limbs being 2/5 on the right lower limb on MRC scale, and 4/5 on the left side of MRC scale, alongwith brisk DTR`s in both lower limbs. Plantar responses were upgoing on both sides. No definite sensory level could be detected. Visual evoked potentials was carried out and showed delayed P100 in the right eye and normal in the left eye. CSF studies showed normal opening pressure, with mild protein elevation reaching 78mg/dl, negative oligoclonal band, and lymphocytic pleocytosis upto 42 cells. Cervical and thoracic MRI showed a swollen cervical cord, with an extensive hyperintense lesion involving the cervical and thoracic cord on T2 wt images from the level of lower medulla down to C7, and T5T10 thoracic levels. Diagnosis of Devic`s disease (neuromyelitis optical) was made, and she received 500mg methylprednisolone for 5 days, with excellent improvement.

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