Objective: We present two pediatric patients with normal neurodevelopment, and incomplete vaccination schedule due to lack of BCG vaccine, who developed hyperkinesias secondary to tuberculous meningitis. In the simple skull tomography, both presented hydrocephalus that required placement of a ventriculoperitoneal shunt valve, cerebrospinal fluid was obtained with changes compatible with meningitis (lymphocytic pleocytosis, hyperprotein and hypoglycorrhachia) and the presence of acid-fast bacilli (AFB) in Ziehl-Neelsen stain.

Background: Acute-onset movement disorders in childhood are rare, with <1% of emergency visits. The main causes include immunologically mediated disorders (Sydenham’s chorea), and infectious diseases.

Method: Case 1: A 5-year-old female presented with drowsiness, fever, and involuntary movements of the right thoracic limb, irregular, predominantly distal over proximal, compatible with hemichorea-hemiballismus. Magnetic resonance imaging of the brain showed subacute infarcts in the basal nuclei bilaterally, with right predominance and basal arachnoiditis.

Case 2: A 11-month-old female presented with oral-intolerance, irritability and drowsiness. On examination, she was found to be comatose, anisochoric, and with irregular breathing, for which intubation, tomography, and VDVP placement were performed. After 72 hours, she developed involuntary movements of the right thoracic limb, predominantly distal, irregular, and continuous, compatible with hemichorea. Contrast-enhanced brain MRI showed subacute infarcts in multiple territories, including bilateral basal nuclei, and basal arachnoiditis.

Results: Both cases received rifampin, pyrazinamide, ethambutol and isoniazid, dexamethasone, and haloperidol, which resolved hyperkinesias.

Conclusion: Although hyperkinesias are infrequent manifestations of tuberculous meningitis (secondary to vasculitic infarcts or tuberculomas), with timely initiation of treatment, the prognosis is good.

References: 1. Cardoso F. Movement disorders in childhood. Parkinsonism Relat Disord. 2014;20 Suppl 1:S13-6.
2. Garone G, Graziola F, Grasso M, Capuano A. Acute Movement Disorders in Childhood. J Clin Med. 2021;10(12).
3. Jhunjhunwala K, Netravathi M, Pal PK. Movement disorders of probable infectious origin. Ann Indian Acad Neurol. 2014;17(3):292-7.
4. Rubio-Hernandez M, Ortiz-Alvarez A, Tello-Martinez N, Vazquez-Guevara D, Rodriguez-Leyva I. Hemichorea-Hemiballism: An Uncommon Presentation of Central Nervous System Tuberculosis. Mov Disord Clin Pract. 2020;7(Suppl 3):S77-S9.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/hyperkinesia-associated-with-tuberculous-meningitis-in-children-report-of-2-cases/