Dados do Trabalho

Título

ACUTE CEREBELLAR ATAXIA DUE TO VARICELLA ZOSTER

Apresentação do caso

A 12-year-old child with a history of varicella infection for 7 days. On the seventh day, the patient presented prostration, inappetence, gait ataxia, dysdiadochokinesia, bilateral eye movement decomposition, pupils equal, round and reactive to light, with no focal deficit and absence of fever. Clinical support, laboratory tests, CSF analysis, and imaging exams were initiated. CSF test and hemogram normal; C-reactive protein test negative; electrolytes, and renal and hepatic function also normal. A neurological consult was requested and dexamethasone and acyclovir were administered in intravenous infusion. The patient evolved favorably showing significant improvement in neurological deficits. Acyclovir was maintained for 14 days and dexamethasone for 07 days. The patient was discharged and referred to an outpatient neurology service.

Discussão

Varicella is highly contagious. Transmission occurs via contact with aerosolized droplets from nasopharyngeal secretions or by direct contact with fluid from skin lesions. The average incubation period is 14-16 days. The period of communicability of patients with varicella is estimated to begin 48 hours before the onset of rash and ends when all lesions are crusted. Mild varicella cases usually include a prodrome of fever, malaise or pharyngitis, and loss of appetite, following the development of generalized vesicular eruptions.After the introduction of the vaccine, the number of complications in children has decreased dramatically, the most common complication is bacterial superinfections. Encephalitis and Reye's syndrome are the most serious complications of varicella. Encephalitis accounts for 20% of pediatric hospital admissions due to varicella, manifesting in two different ways: acute cerebellar ataxia and acute encephalitis. These neurological disorders occur by the end of the first week of the rash. However, in some cases, the neurological manifestations may precede the rash. Acute cerebellar ataxia is more common in children, occurring in about 1 in 4000 varicella infections in children under 15. It has a limited course and is usually followed by complete recovery. Diffuse encephalitis is more common in adults and clinical manifestations include delirium, seizures, and focal neurological signs.

Comentários finais

This case report highlights the importance of informing about and promoting the encouragement of childhood vaccination so that we can reduce the risk of serious complications of vaccine-preventable diseases.

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Não há conflitos de interesses para o estudo citado.

Área

Neuroinfecções