Schilder's disease: case study with serial neuroimaging.
Schilder's myelinoclastic diffuse sclerosis is a rare sporadic demyelinating disease that usually affects children between 5 and 14 years old. The disease often mimics intracranial neoplasm or abscess. We report a 9-year-old girl with Schilder's disease who presented with left hemiparesis. Cranial computed tomography and magnetic resonance imaging (MRI) showed large lesions in the subcortical white matter of the occipital and parietal lobes of both hemispheres that were indistinguishable from an abscess. A cerebrospinal fluid oligoclonal band test was found positive. A diagnosis of acute disseminated encephalomyelitis was then suspected. Serial MRI examinations revealed regression of parenchymal lesions, but there were new developing corpus callosum lesions. After 2 months, the patient presented with right-sided visual loss. MRI examination revealed a right optic nerve lesion. The patient had a dramatic clinical response to corticosteroid therapy. Subsequent control MRI examination revealed regression of both lesions. At 24 months of observation, the patient continued to do well without any complaints or neurologic sequelae.
Kurul
Semra
S
Department of Pediatric Neurology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey. skurul@hotmail.com
Cakmakçi
Handan
H
Dirik
Eray
E
Kovanlikaya
Arzu
A
D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D001922:Brain Abscess / Q000175:diagnosis; D002648:Child; D003337:Corpus Callosum / Q000473:pathology; D002549:Diffuse Cerebral Sclerosis of Schilder / Q000175:diagnosis* / Q000188:drug therapy; D004292:Dominance, Cerebral / Q000502:physiology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004673:Encephalomyelitis, Acute Disseminated / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008279:Magnetic Resonance Imaging; D008775:Methylprednisolone / Q000008:administration & dosage; D009778:Occipital Lobe / Q000473:pathology; D009902:Optic Neuritis / Q000175:diagnosis / Q000188:drug therapy; D010296:Parietal Lobe / Q000473:pathology; D014057:Tomography, X-Ray Computed
D000305:Adrenal Cortex Hormones; D008775:Methylprednisolone