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Alternating Hemiplegia of Childhood in a Child Misdiagnosed As Intractable Epilepsy

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Alternating Hemiplegia of Childhood in a Child Misdiagnosed As Intractable Epilepsy Published online: 2019-09-25 Letters to the Editor a rare complication of HSV‑1 meningoencephalitis: Case report This is an open access article distributed under the terms of the Creative Commons and review of the literature. Scand J Infect Dis 2006;38:63‑6. Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, 8. Shelley BP, Raniga SB, Al‑Khabouri J. An unusual and build upon the work non-commercially, as long as the author is credited and the new late complication of intracerebral haematoma in herpes creations are licensed under the identical terms. encephalitis after successful acyclovir treatment. J Neurol Sci 2007;252:177‑80. Access this article online 9. Li JZ, Sax PE. HSV‑1 encephalitis complicated by cerebral Quick Response Code: hemorrhage in an HIV‑positive person. AIDS Read Website: www.ruralneuropractice.com 2009;19:153‑5. 10. Takeuchi S, Takasato Y. Herpes simplex virus encephalitis complicated by intracerebral hematoma. Neurol India DOI: 2011;59:594‑6. 10.4103/0976-3147.196436 11. Rodríguez‑Sainz A, Escalza‑Cortina I, Guio‑Carrión L, Matute‑Nieves A, Gómez‑Beldarrain M, Carbayo‑Lozano G, et al. Intracerebral hematoma complicating herpes simplex encephalitis. Clin Neurol Neurosurg 2013;115:2041‑5. How to cite this article: Mahale RR, Mehta A, Shankar AK, Miryala A, 12. Yu W, Lee A, Welch B. Herpes simplex encephalitis presents as Acharya P, Srinivasa R. Bilateral cerebral hemorrhage in herpes simplex large temporal lobe haemorrhage. Neurol Cases 2014;1:12‑5. encephalitis: Rare occurrence. J Neurosci Rural Pract 2016;7:S128-30. Alternating Hemiplegia of Childhood in a Child Misdiagnosed as Intractable Epilepsy Sir, Although she had use two antiepileptic drugs (AEDs) for Neurofibromatosis type 1 (NF1) is an autosomal‑dominant seizures, her attacks continued. In our examination, her vital disorder characterized by café au lait spots, skin‑fold freckles, signs, including the blood pressure, were normal. Her height lisch nodules, cutaneous, subcutaneous, and plexiform and weight were normal for her age. Many cafe au lait spots neurofibromas, optic gliomas, and bony lesions.[1] Alternating and axillary freckles were found on her body. There were no hemiplegia of childhood (AHC) is a predominantly sporadic subcutaneous neurofibromas. Ophthalmic examination was neurodevelopmental disorder characterized by transient revealed optic glioma on the right eye. The remaining of the repeated attacks of hemiplegia on either side of the body. physical and neurological examination was unremarkable. The Other paroxysmal symptoms such as tonic and dystonic developmental assessment was normal. The repeat EEG was attacks, autonomic disturbances, seizures, and oculomotor made and found normal. Her cerebral MRI was compatible with abnormalities could occur.[2] Here, we present an NF1 patient NF1 [Figure 1]. Clinical and laboratory findings suggested AHC, with AHC who misdiagnosed as intractable epilepsy. mutation analysis of the ATP1A3 gene performed, and revealed a novel mutation p.P842P (c. 2526G>A). After the diagnosis, the A 5‑year‑old girl presented to our hospital with a history of patient treated with flunarizine, and she has been asymptomatic intractable epilepsy for 3 years. She was born the first child of for 5 months. a nonconsanguineous marriage at term following an uneventful pregnancy. She had first episode of the left hemiplegia at 2 years, which spontaneously recovered after 6–8 h. On examination, many cafe au lait spots had found on her skin. Magnetic resonance imaging (MRI) of the brain was shown hyperintense lesions in cerebellum, brain stem, and subcortical regions on T2‑weighted images. That state was typical for unidentified bright objects of NF1. An electroencephalogram (EEG) was had performed and found normal. Because of her clinical and laboratory findings, NF1 and epilepsy were diagnosed. She has no family history of NF1 disease. Although she had treated with phenobarbital, the patient had multiple acute attacks of hemiparesis with eye deviation. The attacks were intermittent and of varying location and resolved gradually. On several other admissions, documented findings were mainly of weakness on one side, most commonly the right. This was sometimes accompanied by excessive sweating. They had thought that seizures with Todd’s paralysis. She had taken several medications including Figure 1: Cerebral magnetic resonance imaging showed hyperintesive lesions in phenobarbital, carbamazepine, valproic acid, and levetiracetam. cerebellum, brain stem, and subcortical regions S130 Journal of Neurosciences in Rural Practice ¦ Volume 7 ¦ Supplement 1 ¦ December 2016 Letters to the Editor NF1 is a common, genetically transmitted neurodevelopmental Faruk Incecık, Ozlem M. Herguner disorder with a high potential cause of subcortical focal brain Department of Pediatric Neurology, Medical Faculty, lesions. Neurologic problems in NF1 vary and include malignant Cukurova University, Adana, Turkey brain tumors, cognitive and attention deficits, headaches, and seizures.[1] Previous reports have estimated that seizures occur Address for correspondence: Dr. Faruk Incecık, in approximately 4%–7% of individuals with NF1.[3] AHC is a Toros Mah, Barış Manço Bul. 78178 Sok., rare clinical picture that can manifest before the age of 4 years Yeşilpark Evleri, Kat: 7, No: 13, Çukurova, Adana, Turkey. E‑mail: [email protected] and presents dystonic movements and nystagmus as well as progressive intellectual and motor impairment. These episodes can last from a few minutes to some days. Most cases are References sporadic. Its incidence is reported to be around one in 1 million 1. Friedman JM, Birch PH. Type 1 neurofibromatosis: A descriptive children.[4] In addition, half of the children with AHC may analysis of the disorder in 1,728 patients. Am J Med Genet 1997;70:138‑43. have epilepsy, and these seizures are usually quite distinct from 2. Mikati MA, Kramer U, Zupanc ML, Shanahan RJ. Alternating AHC attacks in their manifestations although they may occur hemiplegia of childhood: Clinical manifestations and long‑term [4] simultaneously. If an EEG is recorded during the seizure, it outcome. Pediatr Neurol 2000;23:134‑41. usually shows an appropriate abnormality, but between seizures 3. Vivarelli R, Grosso S, Calabrese F, Farnetani M, Di Bartolo R, the EEG is normal. We detected normal ictal EEG during her Morgese G, et al. Epilepsy in neurofibromatosis 1. J Child attack. In addition, her former repeat EEG was also normal. Neurol 2003;18:338‑42. Treatment with flunarizine was used and presented good 4. Neville BG, Ninan M. The treatment and management of results, according to other reports, and reduced the number alternating hemiplegia of childhood. Dev Med Child Neurol 2007;49:777‑80. and intensity of the hemiplegia crises.[4] Recently, topiramate 5. Di Rosa G, Spanò M, Pustorino G, Ferrari MD, Stam AH, Sgrò DL, has been found effective in a few children with AHC.[5] After et al. Alternating hemiplegia of childhood successfully treated with the diagnosis, we stopped AEDs and flunarizine was started. topiramate: 18 months of follow‑up. Neurology 2006;66:146. After flunarizine therapy, the attacks were not seen. The diagnosis of AHC depends on the characteristic This is an open access article distributed under the terms of the Creative Commons clinical features, and several authors correlated it with Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, [2] and build upon the work non-commercially, as long as the author is credited and the new migraine. The spectrum of clinical symptoms of AHC is creations are licensed under the identical terms. broad that makes difficulty differential diagnosis. AHC is commonly misdiagnosed as epilepsy. Access this article online Quick Response Code: In conclusion, NF1 and AHC, which are two separate Website: morbidities may also coexist in the same patient and our www.ruralneuropractice.com patient is the first example in the literature. In addition, epilepsy may be seen in the NF1 and also AHC patients. If DOI: AEDs have no effect on the seizures in the patients with NF1, 10.4103/0976-3147.196454 AHC should be considered differential diagnosis. Financial support and sponsorship Nil. How to cite this article: Incecik F, Herguner OM. Alternating hemiplegia Conflicts of interest of childhood in a child misdiagnosed as intractable epilepsy. J Neurosci There are no conflicts of interest. Rural Pract 2016;7:S130-1. Cognitive Impairment among Persons of Rural Background Living with Human Immunodeficiency Virus Infection on Antiretroviral Therapy: A Study from a Tertiary Care Centre of North India Sir, recognition and management of individuals with HAD are Human immunodeficiency virus (HIV) infection is often important for improving quality of their life.[3,4] However, accompanied by progressive neuropsychiatric manifestations it remains understudied despite a significant prevalence of [5‑7] varying between asymptomatic neurocognitive impairment, HIV/AIDS‑affected Indian populations. mood and personality disorders, psychosis, mild cognitive‑motor We studied 356 (male:female 154:202) HIV/AIDS‑affected disorder, and HIV‑associated dementia (HAD).[1,2] Since persons (old and new) aged 10–79 (mean ± SD = 39.67 ± 9.88) it adversely affects adherence to medications, interact years between July 2015 and June 2016 presenting in the socially or ability to work, and employability, early dermatology outpatient clinic and institutional antiretroviral Journal of Neurosciences in Rural Practice ¦ Volume 7 ¦ Supplement 1 ¦ December 2016 S131.
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