Transient unilateral oculomotor palsy and severe headache in childhood Kawasaki disease

Abstract

Transient affliction of the cranial nerves may at times be either the presenting feature or complication of otherwise uncomplicated Kawasaki disease (KD) in infants and children. The present report describes a 6 year 9 month old boy with classical KD who developed right-sided oculomotor nerve palsy (manifested by ipsilateral ptosis and medial rectus palsy) resulting in symptoms like severe nausea, intense frontal headache and double vision. The palsy resolved within 5 days of intravenous immunoglobulin therapy, with no residual ophthalmological abnormality at 6 weeks. Besides increased intracranial pressure, which commonly occurs during the course of KD in children, secondary to aseptic meningitis, intense headache in such children may have cranial nerve paresis as accentuating factors.

Ptosis as a complication of Kawasaki disease

“…There have been more than 40 cases of facial nerve palsy reported in the medical literature 9. Transient unilateral oculomotor palsy has been reported with accompanying double vision and unilateral ptosis 10. The ptosis in our case was not the result of oculomotor nerve injury as the eyelid drop was bilateral and symmetrical, the pupil examination was normal and central cranial pathology was excluded by MRI.…”

Kawasaki disease and hepatobiliary involvement: report of two cases

“…However, transient affliction of the cranial nerves may at times be either the presenting feature or a complication of an otherwise uncomplicated KD in infants and children. Oculomotor nerve palsy may resolve after IVIG therapy [ 12 ].…”

Maladie de Kawasaki et atteinte des nerfs crâniens. À propos de 2 observations

“…Dans notre observation, le syndrome de Parinaud était probablement lié à une atteinte inflammatoire du tronc cérébral, malgré la normalité des séquences FLAIR de l'IRM cérébrale et l'absence de réaction méningée. Thapa et al ont rapporté une paralysie oculomotrice du III, s'étant manifestée par des céphalées frontales, une diplopie, une paralysie ipsilatérale et un ptosis de l'oeil droit chez un garçon de 7 ans [8]. Elle avait cédé après cinq jours de perfusions d'immunoglobulines et l'évolution à six semaines avait été parfaite.…”