Grand Rounds

Drooling of saliva

Medical Sciences Department, Pediatric Oncall, Mumbai, India

Address for Correspondence: Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056, India.

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.

What is the diagnosis__?

Discussion :
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

Correct Answers :  yes 2%
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