Title : Drooling of saliva
 
Clinical Problem : An 11 years old give presented with unsteadiness while walking for 1 year, change in voice and dribbling of saliva since 6 months. There is no neuroregression.
 
Question : What is the diagnosis__?
 
Expert Opinion : This child has unsteadiness while walking and change in voice suggestive of either a cerebellar problem or a basal ganglia problem. Since there is drooling of saliva, it is suggestive of basal ganglia involvement. Now basal ganglia diseases that come with unsteadiness while walking and change in voice are Parkinson’s disease, Wilson’s disease, rheumatic chorea and Huntington’s chorea. Both rheumatic chorea and Huntington’s chorea would present with choreoathetoid movements which this child does not have. Parkinson’s disease would present as mask like facies, gait disturbances and slurred slow speech, however dribbling of saliva is not usually present. Neurological manifestations of Wilson’s disease usually have drooling of saliva, and above mentioned symptoms. Thus most likely diagnosis in this child is Wilson’s disease. On further evaluation, she had KF rings and liver dysfunction. Her 24 hours urine copper was 159 mg in 24 hours which increase to 1033 after penicillamine challenge test. Thus, she was diagnosed as Wilson’s disease.

E-published: March 2012 Vol 9 Issue 3 Art No. 18
 
Funding : None
 
Conflict of Interest : None
 
DOI No. : 10.7199/ped.oncall.2012.18
Disclaimer: The information given by www.pediatriconcall.com is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.