Central Pontine Myelinolysis Presenting With Tremor in a Child With Celiac Disease

A 4-year-old boy presented with a history of tremor for 7 days. He also had recurrent diarrhea for the previous 1 year, and poor weight gain. Magnetic resonance of the brain was suggestive of central pontine myelinolysis. There was no evidence of electrolyte abnormalities. The serum tissue transglut...

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Bibliographic Details
Published in:Journal of child neurology 2014-03, Vol.29 (3), p.381-384
Main Authors: Sharma, Preeti, Sharma, Suvasini, Panwar, Neha, Mahto, Deonath, Kumar, Praveen, Kumar, Atin, Aneja, Satinder
Format: Article
Language:English
Subjects:
Biopsy
Brain - pathology
Celiac Disease - complications
Child, Preschool
Diagnosis, Differential
Diet, Gluten-Free
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Male
Myelinolysis, Central Pontine - complications
Myelinolysis, Central Pontine - diagnosis
Myelinolysis, Central Pontine - diet therapy
Myelinolysis, Central Pontine - pathology
Tremor - diagnosis
Tremor - diet therapy
Tremor - etiology
Tremor - pathology
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Summary:A 4-year-old boy presented with a history of tremor for 7 days. He also had recurrent diarrhea for the previous 1 year, and poor weight gain. Magnetic resonance of the brain was suggestive of central pontine myelinolysis. There was no evidence of electrolyte abnormalities. The serum tissue transglutaminase level was markedly elevated, and the duodenal biopsy revealed features of celiac disease. The patient was started on gluten-free diet. The tremor resolved within 3 months. Repeat imaging of the brain done 3 months after starting gluten-free diet showed complete resolution of the lesion. This case highlights the unusual presentation of central pontine myelinosis as tremor in a malnourished child with celiac disease.
ISSN:0883-0738
1708-8283
DOI:10.1177/0883073812475086