Unexplained Weakness and Tremors in Children: A Neurological Concern

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

Hello： You mentioned, "It has been 14 days, the cerebrospinal fluid has been tested and there are no issues, all necessary examinations have been conducted, and the symptoms remain the same. <br>What other tests should be done?" In this case, it may be advisable to consult with p

Unable to walk, feeling weak?

Your question: A child was hospitalized due to severe abdominal pain and a Mycoplasma pneumoniae infection.
The next day, they began experiencing continuous tremors in their hands and feet, generalized weakness, and shortness of breath.
They have been hospitalized for 8 days, during which brain CT scans, echocardiograms, blood tests, and X-rays have all returned normal results.
The doctor indicated it is likely a viral infection, but currently, the child only has mild abdominal pain, and the involuntary shaking of their hands and feet persists, causing pain and increasing weakness in their limbs (they are currently unable to walk).
At times, they experience shortness of breath and require supplemental oxygen, and they also have headaches.
The situation has not improved, and the underlying issue remains unidentified.
Thank you.
Prior to the onset of symptoms, the child received growth hormone injections for six months along with GnRH agonist therapy, which has since been discontinued.

Response from the physician: Neurologist Dr.
Jiang Junyi suggests: Hello, you mentioned "Mycoplasma pneumoniae infection, leading to hospitalization, and the next day the child began experiencing continuous tremors in their hands and feet, generalized weakness, and shortness of breath." Some strains of Mycoplasma can potentially affect the nervous system.
Please refer to: https://www.medlink.com/articles/mycoplasma-pneumoniae-infection-neurologic-complications.
If symptoms persist, a cerebrospinal fluid examination may need to be considered.

Now, 14 days later, cerebrospinal fluid has also been tested, and there are no issues.
All necessary examinations have been conducted, but the symptoms remain unchanged.
What further tests should be considered, and in which direction should we proceed? Thank you.

Xiao Yi, 10~19 year old female. Ask Date: 2022/03/18

Dr. Jiang Junyi reply Neurology

Hello: You mentioned, "It has been 14 days, the cerebrospinal fluid has been tested and there are no issues, all necessary examinations have been conducted, and the symptoms remain the same.
What other tests should be done?" In this case, it may be advisable to consult with pediatric neurologists and pediatric rehabilitation specialists, as they might consider some rare diseases.
Additionally, if there are symptoms related to viral involvement with the nervous system, rehabilitation should begin after the acute phase.
I recommend discussing the next steps in treatment and management (such as rare diseases, infection control, rehabilitation plans, etc.) with your child's attending physician.
Thank you for your inquiry, and feel free to discuss further.
Wishing you and your child good health, peace, and happiness.
Dr.
Jiang Junyi, Taoyuan Hospital, cares for you.

Reply Date: 2022/03/18

More Info

Unexplained weakness and tremors in children can be a significant concern, especially when accompanied by other symptoms such as difficulty breathing and persistent pain. In your case, the child has been hospitalized for a mycoplasma infection, and despite undergoing various tests—including CT scans, echocardiograms, blood tests, and X-rays—no clear diagnosis has been established. The ongoing symptoms of tremors, weakness, and respiratory issues are understandably distressing for both the child and the family.

Mycoplasma pneumoniae infections are known to cause respiratory illness, but they can also lead to neurological complications. These complications can manifest as encephalitis, myelitis, or peripheral neuropathy, which may explain the neurological symptoms observed in your child. The tremors and weakness could potentially be a result of an autoimmune response triggered by the infection, where the body’s immune system mistakenly attacks its own nervous system.

Given that the cerebrospinal fluid (CSF) analysis returned normal, it is essential to consider other potential causes for the symptoms. Here are some avenues to explore further:
1. Autoimmune Disorders: Conditions such as Guillain-Barré Syndrome (GBS) can present with weakness and tremors following an infection. GBS is characterized by the body's immune system attacking the peripheral nerves, leading to muscle weakness and sometimes paralysis. A thorough evaluation by a neurologist, including nerve conduction studies and electromyography (EMG), may be warranted.

2. Metabolic or Endocrine Issues: Sometimes, metabolic disorders can lead to unexplained weakness and tremors. Conditions such as thyroid dysfunction or electrolyte imbalances should be ruled out. Blood tests to evaluate thyroid function and electrolyte levels could provide additional insights.

3. Toxicological Evaluation: Exposure to certain toxins or medications can lead to neurological symptoms. A review of any medications the child has been taking, including the growth hormone and leuprolide acetate (if applicable), is essential. Some medications can have side effects that impact the nervous system.

4. Further Imaging Studies: If the symptoms persist, additional imaging studies, such as an MRI of the brain and spinal cord, may be necessary to rule out structural abnormalities or lesions that could be contributing to the symptoms.

5. Infectious Disease Consultation: Given the complexity of the case, a consultation with an infectious disease specialist may provide further insights into potential lingering effects of the mycoplasma infection or other infectious agents that could be involved.

6. Psychological Factors: While less likely, it is also essential to consider the psychological impact of prolonged illness and hospitalization on a child. Stress and anxiety can manifest physically, leading to symptoms such as tremors and weakness.

In summary, while the initial tests have not revealed a clear cause for the symptoms, it is crucial to continue working closely with your healthcare team. They may recommend further evaluations based on the evolving clinical picture. Keeping a detailed record of the child's symptoms, including any changes or new developments, can be beneficial for the medical team in diagnosing and managing the condition effectively. Your child's health and well-being are paramount, and persistent advocacy for thorough investigation is essential in navigating this challenging situation.

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