Browsing by Author "Sandakelum, U."

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Acute disseminated encephalomyelitis presenting as bilateral ptosis in a Sri Lankan Child
(Hindawi Pub. Corp., 2022) Kumarasiri, I.; Samararathna, R.; Sandakelum, U.; Muthukumarana, O.; Balasubramaniam, R.; Mettananda, S.
Introduction: Acute disseminated encephalomyelitis is a rare inflammatory demyelinating disease characterized by acute onset polyfocal neurological deficits associated with encephalopathy. It commonly presents with fever, meningism, seizures, ataxia, motor deficits, and bladder dysfunction. Although cranial neuropathies, including optic neuritis and facial nerve palsies, have previously been reported, children presenting with bilateral ptosis is extremely rare. Here, we report a 3-year-old child with acute disseminated encephalomyelitis presenting with acute onset bilateral ptosis due to involvement of the single central levator subnucleus of the oculomotor nerve. Case Presentation. A 3-year-old Sri Lankan boy presented with drooping of the upper eyelids for three days and unsteady gait for two days. He did not have seizures, blurring of vision, limb weakness, swallowing or breathing difficulties, or bladder dysfunction. On examination, he had bilateral ptosis, gait ataxia, and dysmetria. His vision, eye movements, and examination of other cranial nerves were normal. MRI brain revealed high signal intensities involving the subcortical white matter of parietal and occipital lobes, midbrain in the area of single central levator subnucleus of the oculomotor nerve, cerebellar vermis, and right cerebellar hemisphere. Based on the clinical features suggesting polyfocal neurological involvement of the midbrain and cerebellum and characteristic MRI findings, the diagnosis of acute disseminated encephalomyelitis was made. He responded well and rapidly to high-dose intravenous methylprednisolone and showed a complete clinical and radiological recovery. Conclusion: This case report describes a rare presentation of acute disseminated encephalomyelitis, bilateral ptosis due to involvement of the single central levator subnucleus of the oculomotor nerve. It highlights that the presenting manifestations of acute disseminated encephalomyelitis can be subtle and vary; however, timely diagnosis and treatment result in complete recovery.
COVID 19: Downstream effects on developmental care - A case report
(College of Community Physicians of Sri Lanka, 2021) Samararathna, R.; Sandakelum, U.; Mettananda, S.
Introduction: COVID-19 pandemic has had a global impact resulting in increased demand on health systems worldwide. This has invariably resulted in major downstream effects to paediatric developmental care that focuses on identifying and making early interventions to optimize the developmental potential of infants with neurological impairment. Here we present a patient with global developmental delay who had unacceptable delays in getting access to intervention programs due to COVID-19. Case study: A 14-month old girl is admitted with fever and two episodes of right-sided focal convulsions. She was born to healthy non-consanguineous parents without perinatal complications. She had subtle dysmorphism, central hypotonia, microcephaly and global developmental delay. Her developmental age was 6-8 months. Biochemical and microbiological investigations, including SARSCoV- 2 PCR and cerebrospinal fluid analysis, were negative. Her EEG showed theta waves suggesting a structural brain pathology. Further questioning revealed that the baby had not attended well-baby clinics as the clinics were not held due to the COVID-19 pandemic. The mother had identified the baby's developmental delay and had gone to a paediatric tertiary care centre three times. However, she was sent back without a proper assessment claiming that the baby's condition is non-urgent and advised to come back when the COVID-19 pandemic ends. Conclusions/ Lessons learnt: This case illustrates the impact of the COVID-19 pandemic on chronic disabling conditions of children. To minimise these downstream effects, the public health sector should create programs to improve family visits and increase the availability of staff-delivered developmental care.
Cross-fused right-to-left renal ectopia presenting as hypertension in a threeyear-old
(Sri Lanka College of Paediatricians, 2023) Sandakelum, U.; Samararathna, R.; Kumarasiri, I.; Balasubramaniam, R.; Mettananda, S.
No abstract available
Focal seizures as first presentation of Pepper syndrome in a six-week-old girl
(Sri Lanka College of Paediatricians, 2022) Sandakelum, U.; Balasubramaniam, R.; Fernando, M.; Gunasekera, S.; Ganewatte, E.; Fernando, S.; Dissanayake, D.
No abstract available
Multisystem inflammatory syndrome in children: A Sri Lankan case series
(Sri Lanka College of Paediatricians, 2021) Sandakelum, U.; Samararathna, R.; Pathiraja, H.; de Silva, L.; Balasubramaniam, R.; de Abrew, G.; Adihetty, D.; Fernando, M.; Randeny, S.; Mettananda, S.
No Abstract Available