Unexplained Tremors and Weakness in Children: A Neurological Concern

Q: Unexplained Tremors and Weakness in Children: A Neurological Concern

Hello： You mentioned "Mycoplasma infection, which led to hospitalization, and starting the next day, there has been continuous trembling of the hands and feet, general weakness, and difficulty breathing." Some species of mycoplasma can potentially affect the nervous system. <br>Y

Continuous shaking of the limbs (weakness in the extremities), headache, and difficulty breathing?

The child was hospitalized due to severe abdominal pain and a cough caused by a mycoplasma infection.
Starting the next day, they experienced continuous tremors in their hands and feet, generalized weakness, and shortness of breath.
They have undergone a CT scan of the brain, echocardiogram, blood tests, and X-rays, all of which returned normal results.
The doctor suspects a viral infection; however, they have been hospitalized for 8 days, and currently, the abdominal pain has lessened, but the involuntary tremors in the hands and feet persist, occurring continuously upon waking, causing pain.
The weakness in the limbs is increasing (the child is currently unable to walk), and there are episodes of shortness of breath requiring supplemental oxygen.
Additionally, there are complaints of headaches, and the situation has not improved, with no identifiable issues found.
Prior to the onset of these symptoms, the child received growth hormone injections for six months along with leuprolide, which have now been discontinued.

Xiao Yi, 10~19 year old female. Ask Date: 2022/03/11

Dr. Jiang Junyi reply Neurology

Hello: You mentioned "Mycoplasma infection, which led to hospitalization, and starting the next day, there has been continuous trembling of the hands and feet, general weakness, and difficulty breathing." Some species of mycoplasma can potentially affect the nervous system.
You may refer to: https://www.medlink.com/articles/mycoplasma-pneumoniae-infection-neurologic-complications.
If symptoms persist, it may be necessary to consider a cerebrospinal fluid examination.
I recommend consulting your attending physician and referring to a pediatric neurologist.
Thank you for your inquiry, and feel free to discuss any related questions! Wishing you good health and peace.
Dr.
Jiang Junyi, Taoyuan Hospital, cares for you.

Reply Date: 2022/03/11

More Info

The case you've presented raises significant concerns regarding unexplained tremors and weakness in a child, particularly in the context of a recent hospitalization for abdominal pain and a suspected mycoplasma infection. The symptoms of persistent tremors, weakness, and respiratory distress, alongside normal results from various diagnostic tests (CT scan, echocardiogram, blood tests, and X-rays), suggest a complex interplay of neurological and possibly systemic factors.

Firstly, it is essential to understand that tremors in children can arise from a variety of causes, including metabolic disturbances, infections, neurological disorders, and even psychological factors. In this case, the child has been hospitalized for a viral infection, which can sometimes lead to post-viral syndromes characterized by neurological symptoms. Viral infections, particularly those caused by enteroviruses or other neurotropic viruses, can lead to inflammation of the nervous system, resulting in symptoms such as tremors and weakness.

The fact that the child is experiencing continuous tremors and increasing weakness, to the point of being unable to walk, is concerning. This could indicate a potential neurological complication, such as post-infectious encephalitis or myelitis, where the immune response to the viral infection inadvertently attacks the nervous system. The presence of respiratory distress and the need for supplemental oxygen further complicate the clinical picture and may suggest a systemic response to infection or a separate respiratory issue.

Given that the child has been on growth hormone and GnRH analogs (like leuprolide), it is also crucial to consider the potential side effects of these medications. While growth hormone therapy is generally safe, it can occasionally lead to complications, including fluid retention or changes in metabolic status, which could contribute to weakness and respiratory issues. However, the timing of the onset of symptoms in relation to the medication administration should be carefully evaluated by the treating physician.

In terms of management, it is vital to continue monitoring the child closely in the hospital setting. A multidisciplinary approach involving pediatric neurologists, infectious disease specialists, and possibly a pediatric pulmonologist may be necessary to address the complex symptoms. Further investigations, such as MRI of the brain and spinal cord, lumbar puncture for cerebrospinal fluid analysis, and possibly electromyography (EMG) or nerve conduction studies, may be warranted to assess for any underlying neurological conditions.

Additionally, supportive care is crucial. This includes ensuring adequate hydration, nutrition, and respiratory support as needed. If the tremors are causing pain, medications such as muscle relaxants or anticonvulsants may be considered to help alleviate discomfort.

In conclusion, the child's symptoms are concerning and warrant thorough investigation and management. While the initial diagnosis points towards a viral infection, the persistence and severity of neurological symptoms necessitate a comprehensive evaluation to rule out serious complications. It is essential to maintain open communication with the healthcare team and advocate for further testing and interventions as needed to ensure the best possible outcome for the child.

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