4th Pediatric Infectious Diseases Conference
 
 
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Specialist Answers
Question
A patient of 9 yrs presented with delayed milestones in all 4 domains with mental motor at the age of 6 months. There was h/o birth asphyxia, difficulty in swallowing due to pseudobulbar palsy resulting in recurrent aspiration pneumonia. His weight was 30% of expected and height was 70% of expected. o/e had social smile and was able to recognize the mother. He was able to roll over and that was the only mobility. HE had no speech except vocalization, had gross hypotonia with dis locatable shoulder joints.There was no head control. Power was grade 3 in all limbs. sensory system was normal. Deep jerks were exaggerated. Kindly give the differential diagnosis. I find difficult to accept this much hyotonia only with birth asphyxia. Increased jerks are another astonishing finding. Thanks.
Answer
Since he has hypotonia with brisk reflexes, it is suggestive of a central cause. Also since he had history of birth asphyxia, it is quite likely that it could be the cause. One can confirm it with an MRI.
 
 
 
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