Chronic Progressive Lower Motor Neuron Tetraparesis in an 11-Year-Old Child: A Rare Case

Abstrak

Background:  Chronic progressive tetraparesis with Lower Motor Neuron (LMN) type is a rare neurological condition in children, characterized by progressive weakness of all four limbs with signs of lower motor neurons. Some examples of neuromuscular disorders in children include Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis (MG), muscular dystrophy, and myotonic dystrophy. Early identification and accurate diagnosis are crucial for prognosis and long-term management.Objective: To report a case of a child with chronic progressive tetraparesis of the LMN type in children who presented with atypical clinical features and required several additional tests to establish the diagnosis.Case Presentation: Case report of an 11-year-old child who presented with the main complaint of weakness in all four limbs that had lasted for the past 5 months, with slow progression. Physical examination revealed hypotonia, hyporeflexia, and no signs of upper motor neuron involvement. The patient required supportive examinations, including MRI, EMG, and cerebrospinal fluid analysis, to support the diagnosis of chronic progressive LMN motor neuron disorder.Conclusion: The diagnosis points to progressive chronic LMN disorder. Several relevant differential diagnoses include Duchenne Muscular Dystrophy (DMD), neuropathy caused by anti-TB drugs (isoniazid), Guillain-Barré Syndrome (GBS), Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP), and possibly tuberculous spondylitis. However, the absence of EMG results, spinal MRI, or muscle biopsy means that a definitive diagnosis cannot yet be established.