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Escudier A, Giabicani E, Neven B, Gouache E, Blanchard M, Isapof A, Nougues MC, Freihuber C. Paroxysmal strabismus and stridor acquired in childhood: Do not overlook calcemia! Arch Pediatr 2020; 27:104-106. [PMID: 31955955 DOI: 10.1016/j.arcped.2019.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 12/30/2019] [Indexed: 01/21/2023]
Abstract
Hypocalcemia is known to induce stridor but was rarely reported to cause strabismus. We report the case of a 4-year-old girl who presented with paroxysmal stridor and strabismus with diplopia, persisting for several weeks. Severe hypocalcemia (1.25 mmol/L) was finally diagnosed and was related to hypoparathyroidism, which was the first manifestation of autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) in this patient. Strabismus and stridor both resolved after normalization of calcemia. This case report is a rare observation of paroxysmal strabismus caused by hypocalcemia and it highlights the importance of calcium monitoring in any situation of atypical neurological symptoms.
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Affiliation(s)
- A Escudier
- Service de Neurologie Pédiatrique, AP-HP, GHUEP, Hôpital Armand Trousseau, 75012 Paris, France.
| | - E Giabicani
- Hôpitaux de Paris (APHP), Hôpital Armand Trousseau, Explorations Fonctionnelles Endocriniennes, 75012 Paris, France; Sorbonne Université, Inserm, UMR_S 938 Centre de Recherche Saint Antoine, Assistance Publique, 75012 Paris, France
| | - B Neven
- Service d'Immuno-Hématologie, APHP, Hôpital Necker-Enfants malades, 75015 Paris, France; Sorbonne Paris Cité, Institut Imagine, Université Paris Descartes, 75015 Paris, France
| | - E Gouache
- Service d'Hématologie Pédiatrique, AP-HP, GHUEP, Hôpital Armand Trousseau, 75012 Paris, France
| | - M Blanchard
- Service d'Oto-Rhino-Laryngologie, AP-HP, Hôpital Necker-Enfants malades, 75015 Paris, France
| | - A Isapof
- Service de Neurologie Pédiatrique, AP-HP, GHUEP, Hôpital Armand Trousseau, 75012 Paris, France; Service de Neuropédiatrie et Centre de Référence des Pathologies Neuromusculaires "Nord/Est/Ile-de-France", GRC ConCer-LD, Sorbonne Universités, UPMC Univ Paris 06, Hôpital Trousseau, AP-HP, FILNEMUS, 75012 Paris
| | - M-C Nougues
- Service de Neurologie Pédiatrique, AP-HP, GHUEP, Hôpital Armand Trousseau, 75012 Paris, France; Service de Neuropédiatrie et Centre de Référence des Pathologies Neuromusculaires "Nord/Est/Ile-de-France", GRC ConCer-LD, Sorbonne Universités, UPMC Univ Paris 06, Hôpital Trousseau, AP-HP, FILNEMUS, 75012 Paris
| | - C Freihuber
- Service de Neurologie Pédiatrique, AP-HP, GHUEP, Hôpital Armand Trousseau, 75012 Paris, France; Sorbonne Université, GRC ConCer-LD, Hôpital Armand Trousseau, 75012, Paris, France
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Sunder RA, Singh M. Pseudohypoparathyroidism: a series of three cases and an unusual presentation of ocular tetany. Anaesthesia 2006; 61:394-8. [PMID: 16548962 DOI: 10.1111/j.1365-2044.2006.04543.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pseudohypoparathyroidism is a heterogeneous group of disorders characterised by hypocalcaemia, hyperphosphataemia, increased serum parathormone and insensitivity to the biological activity of parathormone. These patients may present for incidental surgery, procedures related to kidney stones, cataract removals and renal transplants. No particular anaesthetic agent or technique is indicated except that respiratory alkalosis should be avoided as it may further decrease ionised calcium levels and thereby precipitate tetany. In this report, we present the peri-operative management of three patients with this rare condition and describe an unusual presentation of hypocalcaemic extra-ocular muscle spasm.
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Affiliation(s)
- R A Sunder
- Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India, 110029.
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