RESUMEN
A twelve-year-old African-American female presented with two week history of progressively worsening headache and fatigue, and vision difficulties for the past week. The physical examination was normal. The neurological evaluation was normal, except for cranial nerves (CN) testing, which showed bilateral restriction of adduction (CN III) and up gaze (CN IV) motions, vertical nystagmus, and left side facial paresis of central origin (CN VII). The bilateral exotropia and ophthalmoplegia are characteristics of WEBINO (Wall-Eyed Bilateral Intranuclear Ophthalmoplegia) syndrome, associated to a brain stem structural lesion. The following causes were evaluated and ruled out: tumor, infection, ischemic stroke, non-infectious inflammation. Pediatric Acquired Demyelinating Syndromes were then considered. Neuromyelitis Optica was ruled out in the absence of neuritis and normal spinal cord MRI. The differential diagnosis between Clinically Isolated Syndrome and Acute Demyelinating Encephalomyelitis, causing an isolated brain stem syndrome, is discussed.
Asunto(s)
Encefalomielitis Aguda Diseminada/diagnóstico , Oftalmoplejía/diagnóstico , Negro o Afroamericano , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Niño , Diagnóstico Diferencial , Encefalomielitis Aguda Diseminada/tratamiento farmacológico , Encefalomielitis Aguda Diseminada/patología , Encefalomielitis Aguda Diseminada/fisiopatología , Femenino , Humanos , Imagen por Resonancia Magnética , Oftalmoplejía/tratamiento farmacológico , Oftalmoplejía/patología , Oftalmoplejía/fisiopatología , Tomografía Computarizada por Rayos XRESUMEN
This paper reports a case of an olanzapine overdose in a 12-year-old boy. An opioid-like presentation was noted. Despite a high serum level of olanzapine, the patient made a complete recovery and showed no sequelae at follow-up.