Enterovirus-Related Parainfectious Acute Disseminated Encephalomyelitis Presenting With Dorsal Midbrain Syndrome: A Pediatric Case Report

An 8-year-old male patient presented to the pediatric clinic with complaints of cough, cold, lethargy, fever, restricted eye movements, and altered sensorium for one day. A detailed clinical examination revealed bilateral ophthalmoparesis, with left occulomotor nerve involvement leading to limitations of vertical gaze. The patient was referred to the ophthalmology clinic for assessment. Upon evaluation, it was observed that the child exhibited upward gaze palsy and convergence-retraction nystagmus as can be seen in Figure 1. Additional ophthalmological findings included exotropia measuring 40 prism diopters (pd) of the left eye, light near dissociation, convergence absence, and convergence retraction nystagmus, which was induced by the optokinetic nystagmus (OKN) drum. Visual acuity in both eyes was measured at 20/20 measured using Snellen chart at distance. Additionally, the corneal reflexes and fundus examination yielded normal findings. The general physical examination revealed a well-nourished child, with no other systemic abnormalities. The Glasgow Coma Scale was recorded as 12/15 with nonsensical speech.