[May neuroimaging findings of a child with multiple sclerosis surprise us? Clinical and radiological observation].

BACKGROUND: Multiple sclerosis (MS) is a chronic disorder characterized by presence of demyelinating changes in the central nervous system. The disease most often affects young adults with a female predominance, but the first symptoms can also occur in children. MS symptoms in childhood are characterized by a higher incidence of sensory, cerebellar and brainstem disorders compared to adults. They are frequently multifocal especially in the youngest age groups, requiring differentiation of acute disseminated encephalomyelitis. The diagnosis of MS is based on the 2010 McDonald criteria in both children and adults. Dissemination of disease in space and time documented by either clinical and/or radiological findings is necessary for diagnosis establishment. Additional tests used in MS diagnosis are examination of cerebrospinal fluid and examination of exogenous evoked potentials.

CASE REPORT: We describe a case of 11-year-old boy who came to the Department of Pediatric Neurology Chair of Pediatric and Adolescent Neurology Jagiellonian University in Krakow because of severe headache and dizziness, which occurred the day before admission. Neurological examination revealed the presence of balance disorders and signs of the pyramidal tract involvement. Head MRI revealed disseminated demyelinating lesions in typical for MS localization with the presence of one active, gadolinium-enhancing lesion. Examination of cerebrospinal fluid showed oligo-clonal bands. Results of exogenous evoked potentials were normal. The patient received high-dose intravenous (pulse) methylprednisolone therapy with good clinical outcome. At that time the patient did not meet requirements for interferon therapy financed from the state budget because of too young age.

CONCLUSIONS: Pediatric-onset MS has a slightly different clinical presentation compared to adult-onset MS. The neuroimaging findings may be sometimes surprising showing a large discrepancy between advanced radiological changes and clinical outcome.