Schilder’s disease- encephalitis periaxialis diffusa Singhal N C – Indian J Ophthalmol diffuse anoxic brain injury

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How to cite this article: singhal N C. Schilder’s disease- encephalitis periaxialis diffusa. Indian J ophthalmol 1965;13:119-20

How to cite this URL: singhal N C. Schilder’s disease- encephalitis periaxialis diffusa. Indian J ophthalmol [serial online] 1965 [cited 2018 jan 30];13:119-20. Available from: http://www.Ijo.In/text.Asp?1965/13/3/119/39231

Schilder’s disease is a rare demye­linating disorder affecting chiefly the subcortical white matter of cerebral hemisphere. It generally affects infants and children and is characterised by progressive spastic paralysis, cortical blindness and death.


Case report

Pushpa a female child aged six years attended the eye department of well­ington hospital on 8th jan. 1959 with a complaint of dimness of vision in the right eye for about two months.Diffuse anoxic brain injury

On examination there was central corneal opacity in the right eye and a right divergent squint of about 10 to 15 degree. The child could not count fingers with that eye, whereas she could do that with the left eye. The right eye pupil was dilated and was reacting sluggishly to light, probably because of previous use of a mydriatic at another hospital. The fundus was normal. The left pupil and fundus were normal. No satisfactory decision could be arrived at as to the diagnosis.

On 28th jan. 1959 the child was brought again to the department with the complaint that now she could not see with the left eye also. This was detected by the parents when the child while walking in the house struck against objects lying on the floor and fell down.Diffuse anoxic brain injury another complaint was that the child wept for the last one week whenever her head was combed and had been sitting idle. History of mild fever could be elicited with diffi­culty from the parents.

On examination both pupils were normal in size, shape and reaction to light both in speed and range. Fundii were normal. The child did not reply when asked to count fingers and was unable to co-operate for testing ocular movements which however appeared to be normal. She appeared to be list­less and was not interested to catch even toys, unless put in her hands. There was no menace reflex.

The central nervous system and other systems on examination were found normal. Physically and mentally the patient was normal till the recent illness.Diffuse anoxic brain injury there was no birth or deve­lopmental defect.

Examination of the blood revealed a low R.B.C. Count (2.6 million) with 50% hoemoglobin. The white blood count, total and differential was nor­mal. Blood sedimentation rate (wester- green) was 60 mm in one hour. The cerebro-spinal fluid was under normal pressure, and nothing abnormal was detected in its examination. Stool and urine examinations, X-ray of the skull and encephalography showed nothing abnormal.

The child was put on prednisolone by mouth on an empirical basis and was given inferon for her anaemia. There was no change in the condition even after 15 days of treatment.

In view of the normal pupils, normal fundi, total loss of vision, age and in­vestigation results within normal limits, a diagnosis of schilder’s disease was made.Diffuse anoxic brain injury A course of histamine dipho­sphate injections one mgm intra­muscularly bi-weekly was advised, in­creasing the dose by one mgm every week for one month.

The child was again seen on the 6th march 1959. There was no change in the eye condition. On the contrary, nerve deafness was suspected but could not be confirmed because of the child’s inability to respond. It had become more dull and apathetic now.

A month later the child suddenly fell to the floor and was put to bed. Since then she could not stand but could sit. On examination, there was spastic paralysis of the legs. The upper extremities were similarly affected but to a lesser extent. Her appetite be­came poor. On the 7th day of con­finement to bed parents reported that there was incontinance of urine and stools and she was daily getting worse.Diffuse anoxic brain injury the child died on 25th april.

No autopsy was done.

Discussion

Schilder described the disease in 1912 and since then the diagnosis has been made in many instances only at autopsf, which emphasizes the diffi­culty in diagnosis. Brain and strauss state that there is no other disease af­fecting young adults and children in which the following triad is present.

• progressive loss of vision.

• progressive spastic paralysis.

• progressive mental deterioration.

These three features may be present simultaneously, when the condition is rapidly fatal, or independently, the other features developing subsequently. Because of extreme rarity of schilder’s disease, its diagnosis on symptomato­logy of progressive spastic paralysis or progressive mental deterioration alone will seldom be thought of because there are other conditions which are initiated with similar symptomatology.Diffuse anoxic brain injury the logical conclusion of progressive loss of vision without pupillary dis­turbances is that the lesion is cortical and the only possibility of such a lesion is schilder’s disease. Other possible lesions are vascular and tumours which will have their own features for diag­nosis. Investigations like X-ray skull, lumber puncture, encephalography, would no doubt be done but all these are likely to be normal. Diagnosis can only be confirmed by autopsy.

The common modes of onset of the disease may be as follows:

• progressive mental deterioration in the form of irritability, peev­ishness, unprovoked laughing.

• disturbances of motility such as hemiplegia unilateral or bilateral. Monoplegia and cortical paraple­gia.Diffuse anoxic brain injury

• cortical blindness may be the first symptom.

The blindness is due to extensive sym­metrical lesions in the optic radiations of both cerebral hemispheres. Sensory symptoms are difficult to elicit because of mental changes but any variety of sensory lesions may be found.

Headaches occur frequently. Rarely optic nerves may be attacked by the process, but when they are involved, choked discs add to the diagnostic pro­blem. These signs and symptoms lead to frequent diagnosis of cerebral tumours and unsuccessful exploratory operations performed in these patients.

The present case began with cortical blindness and developed later into cor­tical deafness and disturbances of motility. Death came earlier than mental symptoms. [2]

diffuse anoxic brain injury

Summary

A case of schilder’s disease is des­cribed. A brief review of the literature is given.

References

1.