Constructional apraxia secondary to frontal lobe lesion in pediatric acute disseminated encephalomyelitis

Abstract

  Constructional apraxia (CA) is caused by lesions in the bilateral parietal lobes as well as those in the frontal lobe due to frontotemporal dementia. However, there have been no reports of a pediatric case of CA resulting from frontal lobe lesions. We report a case wherein CA developed in a 9-year-old boy with acute disseminated encephalomyelitis (ADEM) and a right frontal lobe lesion. The patient presented to the hospital with complaints of fatigue and back and neck pain. Brain MRI revealed a white matter lesion in the right frontal lobe. Serum anti-myelin oligodendrocyte glycoprotein antibodies were detected. He was diagnosed with ADEM, and was treated with an initial course of pulse intravenous methylprednisolone, which improved the symptoms. However, CA was revealed by evaluation of higher brain dysfunction. Therefore, he received a second course of pulse intravenous methylprednisolone, and subsequently recovered from CA. Higher brain dysfunction is not listed as a main clinical manifestation of pediatric ADEM ; nonetheless, its evaluation led to a better clinical decision in this case. The assessment of higher brain dysfunction could be useful in making an appropriate treatment plan for pediatric central nervous system diseases.