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Abstract: The child was a 10-month-old boy. At the time of consultation, the mother reported that the child had been out in the cold 2 days earlier and had developed fever after exposure to wind. The child was diagnosed as having cervical sympathetic nerve palsy syndrome, and his mother was instructed to apply heat and massage to the child, and the child’s eyes were found to be symmetrical in size and the facial flushing improved significantly.
Basic information】Male, 10 months old
Disease Type】Pediatric cervical sympathetic nerve palsy syndrome
Hospital】Shanghai Sixth People’s Hospital
Date of Consultation】November 2021
Treatment Plan】Appropriate hot compresses and massage at home, close observation
Treatment Period】One week of home observation, one week of outpatient follow-up
Results】The size of both eyes returned to symmetry, and the facial flushing improved significantly.
I. Initial consultation
A mother brought her 10-month-old baby boy to the clinic. The mother reported that she suddenly found that her child’s eyes were not the same size in the past 2 days, the right eye was obviously smaller, the left facial skin was flushed, and there were no other uncomfortable symptoms. Since the child’s symptoms were typical, the diagnosis of pediatric cervical sympathetic nerve palsy syndrome was made from the presentation. When asked about the child’s medical history, the mother said that the child had a fever 2 days ago, and that the child’s temperature was 37.9°C after being out in the cold and wind, accompanied by a little nasal congestion and runny nose, and that the temperature was quickly reduced to normal by physical cooling, without using antibiotic drugs.
II. Treatment
Through communication with the family, it was found that the child had no underlying disease, was in good health before, had sudden onset of bilateral eye asymmetry, and had a history of previous antecedent infection. After discussing with the mother, we decided not to give any medication or other auxiliary treatment. In addition, the child should rest at home and go out less to avoid re-infection, and closely observe the condition.
III. Treatment effect
One week later, the family brought the child back to the outpatient clinic for a follow-up visit, and found that the child’s previous abnormal symptoms had basically disappeared, the asymmetric facial flushing had improved, the size of both eyes had returned to normal symmetry, and his mental status, reaction, vitality, appetite, and sleep were all basically normal. The family members were advised to go out for appropriate activities afterwards, but to be careful to avoid re-infection.
IV. Notes
We are glad that the child’s condition has been controlled without the use of medication after an accurate judgment of the child, and the prognosis is good, but since the child was born recently and is still young, the immune function of the body is not as strong as that of adults, so there is still a possibility of recurrence in daily life. Especially in winter and spring when viral infections are prevalent, it is important to take warmth and wind protection measures when going out to avoid direct blowing of cold wind, and to avoid taking the child to crowded places to avoid the possibility of viral infections as much as possible.
V. Personal insight
Pediatric cervical sympathetic nerve palsy syndrome is characterized by a slight sunken eye, narrow pupils, drooping upper eyelids, flushed face on the opposite side, and little sweating on the same side. There are many causes of the disease, such as trauma, inflammation, surgery, infection, tumor, and vascular lesions.
In this case, the diagnosis is clear: secondary temporary neuropathy caused by a pre-existing respiratory virus infection, which is not uncommon in young infants and requires close monitoring and protection by parents.
Since the immune system of young infants is weak, parents need to take better care of them to avoid bacterial, viral, mycoplasma or other infections in the external environment, which may cause the disease. In addition to the most common symptoms of fever, parents need to be alert to other systemic manifestations, such as respiratory, digestive, skin and neurological, and to closely observe any facial expressions or gait asymmetry, especially if the symptoms worsen progressively and do not resolve on their own, and to consult a pediatric neurologist promptly.