Clinical Briefs

Indian J Pediatr 1997; 64 : 119-120

i

Mumps Hemiplegia
Rajiv Anand, R. Anand, M. Gupta, T. Mondal and J. Chandra

Department of Neurology G.B. Pant Hospital and Department of Radiology and
Pediatrics, Kalawati Saran Children's Hospital, New Delhi
Abstract : Neurological involvement of mumps is commonly restricted to aseptic meningitisl,L
However, rarely mumps is associated with more severe encephalitic illness1.3; other known
associations described with mumps are cases of transverse myelitis and Gullain Barre like illness 3.
We report a case of hemiplegia due to mumps parotitis probably caused by involvement of carotid
artery. (Indian J Pediatr 1997; 64 : 119-120)

Key words : Aseptic meningitis; Encephafitis; Myelitis; Hemiplegia; Carotid artery
CASE REPORT

An 11-year-old male child presented with
a febrile illness associated with bilateral
parotitis, not associated with headache,
vomiting, confusion, disorientation and
hallucinations. There was diffuse painful
swelling over both angles of jaw, more
marked on right side. The swelling on the
right side was immobile, soft to firm in
consistency, tender to touch occupying the
region over the parotid and conforming to
its shape and displacing the ear lobule upwards. There was no history of urinary or
bowel complaints. The child was febrile
(temp - 101~ Neurologicaal examination
was normal. Chest, C.V.S, per abdominal
examinations were normal. Patient was
not treated with antibiotics and made an
uneventful recovery from his primary illness. Seven days after this illness the child
developed sudden weakness of left half of
the body. There was no history of convul-

Reprint requests : Dr. Rajiv Anand, A-203,
Meera Bagh, Outer Ring Road, Delhi-l10041.

sion or loss of consciousness or
behavioural changes. On examination the
child was conscious, cooperative. Bilateral
carotids were palpable. There was no evidence of cranial nerve palsy. Upper motor
neurone type of weakness was found in
left upper limb and lower limb. No
meningeal signs were present, C.T. scan
head revealed both the cerebellar hemispheres and brainstem were normal.
Fourth ventricle was in midline. Supra
tentorial region showed a well defined low
attenuating lesion in periventricular region
on right side. Both the lateral ventricles
were normal in size, shape and position
and interventricular septum was in midline. Third ventricle and basal cisterns
were normal. Elsewhere cerebral parenchyma was normal (Fig. 1). A diagnosis of
right periventricular parietal infarct was
given. Child showed gradual recovery. After 6 days the power in limbs returned to
near normal.
In view of rapid recovery from hemiplegia and for an association with mumps carotid angiography was not performed.

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THE INDIAN JOURNAL OF PEDIATRICS

Fig. 1. CT-scan head showing low attenuating
lesion in right periventricular region
suggestive of infarct.

1997; Vo]. 64. No. I

parotitis child was p r e s e n t e d with left
sided h e m i p l e g i a . The child after the dev e l o p m e n t of h e m i p l e g i a was fully conscious. There w e r e no b e h a v i o u r a l disturbances or cranial n e r v e palsies eliminating
the possibility of encephalitis as the cause
of h e m i p l e g i a . Also CT scan r e v e l a e d left
p e r i v e n t r i c u l a r parietal infarct w i t h normal right c e r e b r a l h e m i s p h e r e , w h e r e a s
encephalitis as a l r e a d y stated r a r e l y involves only one hemisphere4'L It is said
that the i n f l a m m a t i o n of ear, nose, throat
or paranasal sinuses in children are associated w i t h cervical l y m p h a d e n o p a t h y .
These enlarged l y m p h n o d e s by their proximity involve the adventitia of the internal
carotid a r t e r y w i t h s u b s e q u e n t d e v e l o p m e n t of intra vascular t h r o m b o s i s a n d resultant hemiplegia 4'7. In the present case as
the possibility of encephalitis was r u l e d
out, t h e r e f o r e , the p r o b a b l e aetiological
factor for h e m i p l e g i a m i g h t be carotid
artheritis with resultant t h l o m b o s i s of internal carotid artery.

DISCUSSION
REFERENCES

Acute h e m i p l e g i a in c h i l d h o o d is a n o n specific r e s p o n s e of n e r v o u s s y s t e m to
various causative factors. Hemiplegia m a y
follow an attack of c h i l d h o o d infective illness such as pertussis, m u m p s , measles,
chicken pox3'~'L H o w e v e r , h e m i p l e g i a following m u m p s is quite rare t h o u g h different forms of paresis as a sequelae of CNS
mumps have been reported by different
authors 1. The u n d e r l y i n g m e c h a n i s m for
producillg hemiplegia may be encephalitis,
convulsion associated with the illness or a
vascular lesion d e s c r i b e d b y v a r i o u s authors 3'5. H o w e v e r , encephalitis of viral origin is only occasionally c o m p l i c a t e d b y
h e m i p l e g i a as it r a r e l y involves o n l y one
hemisphere ~.~'.
In the present case, the patient was presented with right p a r o t i d swelling a n d fever - - the classical features of m u m p s
parotitisL S e v e n d a y s after m u m p s ,

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