Primer episodio de enfermedad desmielinizante en edad pediátrica: serie de casos

Abstract

Encefalomielitis aguda diseminada, esclerosis múltiple, síndrome clínicamente aislado y neuromielitis óptica. Estos pacientes usualmente previamente son sanos, y en un primer evento clínico neurológico las posibilidades diagnósticas son numerosas: encefalitis (infecciosa o autoinmune), intoxicación por fármacos o drogas de abuso, lesión ocupante de espacio intracraneal o enfermedad desmielinizante como esclerosis múltiple. La presentación clínica puede ser: déficit neurológico focal o multifocal, agudo o subagudo, y asociado o no a encefalopatía. El diagnóstico depende principalmente de los hallazgos clínicos, características de la resonancia magnética (RM) cerebral o medular y los biomarcadores en sangre (anticuerpos) o líquido cefalorraquídeo, bandas oligoclonales. Se presentan 3 casos clínicos en pacientes pediátricos atendidos en centro médico docente la trinidad entre 2022 y 2023 que cursaron con sintomatología similar, estableciéndose diagnóstico de síndrome desmielinizante multifocal, presentaron neuritis óptica y anticuerpos glicoproteína de oligodendrocitos de mielina (MOG) positivos.

Demyelinating diseases in pediatric age are rare, but not exceptional. They can be divided into four large groups: acute disseminated encephalomyelitis, multiple sclerosis, clinically isolated syndrome and neuromyelitis optical. These patients are usually previously healthy, and in a first neurological clinical event the diagnostic possibilities are numerous: encephalitis (infectious or autoimmune), intoxication by drugs or drugs of abuse, lesion occupying intracranial space or demyelinating disease such as multiple sclerosis. The clinical presentation may be that of a focal or multifocal neurological deficit, acute or subacute, and associated or not with encephalopathy. The diagnosis of these disorders depends mainly on clinical findings, characteristics of brain or spinal magnetic resonance imaging (MRI), and biomarkers in blood (antibodies) or cerebrospinal fluid, oligoclonal bands. The description of 3 clinical cases is presented in pediatric patients treated at the la trinidad teaching medical center between 2022 and 2023 that presented with similar symptoms, establishing a diagnosis of multifocal demyelinating syndrome, of which optic neuritis and oligodendrocyte glycoprotein antibodies were present in all of them. Myelin (MOG) positive