Clinical Reasoning: A 6-Year-Old Girl With Right-Sided Pain and Weakness

We outline the case of a 6-year-old girl presenting with a 2-week course of waxing and waning neurologic symptoms, including right-sided pain, weakness, dizziness, and difficulty walking. Her examination was notable for right-sided weakness, hyperreflexia, and dysmetria. Diagnostic evaluation was significant for MRI with numerous T2 hyperintense, T1 hypointense, and T1-enhancing lesions located in the juxtacortical and periventricular regions, corpus callosum, brainstem, and spinal cord; positive CSF oligoclonal bands; negative serum aquaporin-4 immunoglobulin G (IgG) and myelin oligodendrocyte glycoprotein IgG; and positive serum Epstein-Barr viral capsid antigen IgG.

Automated summary

We present a 6-year-old girl with waxing and waning neurologic symptoms, including pain, weakness, dizziness, and difficulty walking. MRI revealed multiple lesions in various regions of the brain and spinal cord, while CSF analysis showed positive oligoclonal bands. Blood tests were negative for specific antibodies but positive for Epstein-Barr viral capsid antigen IgG.