Multiple sclerosis (MS) is described as an inflammatory, demyelinating, neurodegenerative disorder of the central nervous system (CNS) and is uncommonly seen in pediatric patients. Pediatric MS represents about 2.2% to 4.4% of all MS cases, in late childhood, affects more girls than boys, and is characterized by a relapsing-remitting course in almost cases. Although, much knowledge has been achieved on the diagnosis and treatment of adult patients with MS, it remains a matter of debate and controversy in childhood.
A 9-year-old girl was referred for neurological examination due to sudden onset of diplopia. The patient affirmed that after waking up on that morning, she started to feel visual impairment in which an object was seen as two while having both eyes open. She also said that the distance between the two objects enlarged when looking to the left. Her past medical and familial history was unremarkable for any degenerative or neurological disorder. General clinical assessment of the patient was found within normal limits. Neurological examination revealed convergent strabismus and no movement of the left lateral rectus muscle. The remainder of the exam was essentially normal, including visual fields and routine ophthalmoscopy. Blood laboratory exams and electrocardiogram were found to be normal. Magnetic resonance imaging (MRI) of the brain showed multiple lesions affecting the periventricular, juxtacortical and infratentorial regionsBrain MRI also showed gadolinium-enhancing and nonenhancing lesions A cerebrospinal fluid analysis was unremarkable. As no other structural abnormalities were identified, a diagnosis of multiple sclerosis (MS) was made and the neurological symptom was attributed to it. Based on this diagnosis, we started pulse corticosteroid therapy with methylprednisolone during three days. The girl did not recover after 6 months of the diplopia and is currently being followed on outpatient appointments.