title: Multiple sclerosis in the very young: a case report and review of the literature.
abstract: Onset of multiple sclerosis (MS) in the very young (<10 years) is uncommon. We describe a 2 year old girl with MS, the youngest reported case in the USA. She presented to an outside hospital with acute onset of ataxia on three occasions before presenting to our institution, initially misdiagnosed as acute disseminated encephalomyelitis and treated with intravenous methylprednisolone. MRI of the brain during each presentation revealed new areas of demyelination. Initial cerebrospinal fluid (CSF) studies and MRI of the spine were normal. Repeat MRI of the brain at our institution, 7 months later, revealed new demyelinating lesions and CSF analysis revealed elevated myelin basic protein, negative oligoclonal band and neuromyelitis optica immunoglobulin and normal IgG synthesis. Her clinical presentation with multiple relapses and new MRI findings validated the diagnosis of MS.
authors.affiliation: Center for Pediatric Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Indu
authors.initials: I
authors.lastname: Sivaraman
authors.affiliation: Center for Pediatric Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Manikum
authors.initials: M
authors.lastname: Moodley
mesh_terms: D002675:Child, Preschool; D003951:Diagnostic Errors; D004673:Encephalomyelitis, Acute Disseminated / Q000175:diagnosis; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009103:Multiple Sclerosis / Q000134:cerebrospinal fluid / Q000473:pathology*; D004676:Myelin Basic Protein / Q000134:cerebrospinal fluid
chemical_list: D004676:Myelin Basic Protein
keywords: ADEM; demyelinating disease; early childhood; multiple sclerosis; very young children