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Paediatric rhombencephalitis presenting with bradycardia: a good recovery despite cardiac involvement
  1. Victoria Stokes1,
  2. Sarah Milner2 and
  3. Julia Surridge3
  1. 1Emergency Medicine, Royal Derby Hospital, Derby, UK
  2. 2Paediatrics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  3. 3Children's Emergency Department, Royal Derby Hospital, Derby, UK
  1. Correspondence to Dr Victoria Stokes; victoria.stokes1{at}nhs.net

Abstract

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.

  • emergency medicine
  • brain stem / cerebellum
  • paediatrics
  • headache (including migraines)

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Footnotes

  • Contributors VS and JS undertook the medical assessment of the patient in the Emergency Department, forming the conception and design of the work and collection of data. VS wrote the article with SM and JS contributing to the drafting, revising and final approval of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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