Paediatric rhombencephalitis presenting with bradycardia: a good recovery despite cardiac involvement.
Rhombencephalitis is a rare condition, often caused by infection, commonly presenting with myoclonic jerks, ataxia and cranial nerve palsy. Typically, it has a high morbidity and mortality, with worse prognosis associated with cardiopulmonary involvement. Herein, we present the case of a 10-year-old boy, presenting with headache, vomiting, symptomatic bradycardia and rapidly progressing ophthalmoplegia from a sixth nerve palsy, without additional brainstem symptoms. Previously, pericarditis, myocarditis and heart failure have been associated with rhombencephalitis, but not bradycardia. The cause of his rhombencephalitis was presumed viral, but despite extensive screening, the virus responsible was never isolated. Following treatment with intravenous antibiotics and antivirals in a high dependency unit, he recovered well with no neurological deficit on discharge and marked radiological improvement on MRI 4 weeks later. Although rare, rhombencephalitis should be considered in a child presenting with neurological symptoms, particularly alongside a cranial nerve palsy, developing over a rapid time course.
['Stokes|Victoria|V|', 'Milner|Sarah|S|', 'Surridge|Julia|J|']
D000900:Anti-Bacterial Agents D001919:Bradycardia D001933:Brain Stem D002648:Child D006801:Humans D008279:Magnetic Resonance Imaging D008297:Male D009205:Myocarditis
paediatrics brain stem / cerebellum emergency medicine headache (including migraines)