{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T17:45:34Z","timestamp":1777657534697,"version":"3.51.4"},"reference-count":22,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100005302","name":"university of illinois at urbana-champaign","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005302","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Pediatric Health"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:p>\n                    A previously healthy, unimmunized, 3-year-old Caucasian boy presented to the emergency department with right-sided facial droop, clumsiness, and intermittent bilateral hip pain. Two weeks ago, he had 24 hours of self-resolving rhinorrhea and fever. Examination was significant for right facial nerve palsy, lower extremity pain, areflexia of his right lower extremity, and diminished reflexes of his left lower extremity. He was admitted for urgent magnetic resonance imaging of the brain. Cerebrospinal fluid (CSF) protein was 85 mg\/dL with elevated albumin and immunoglobulin, and CSF white blood cell was 3 cells\/mm\n                    <jats:sup>3<\/jats:sup>\n                    . Serum Mycoplasma immunoglobulin (Ig) M and IgG were elevated. There was concern for Guillain-Barr\u00e9 syndrome (GBS). He was started on intravenous IG (IVIG) and was treated for presumed Mycoplasma infection. Weakness and gait disturbances in a child can present the clinician with a diagnostic challenge. Gait disturbance may indicate a neurological lesion anywhere from the central nervous system to the peripheral nerves, neuromuscular junction, or muscle. In the present case, the combination of peripheral facial palsy, presumed neuropathic pain, gait difficulties, and areflexia in the setting of an antecedent respiratory illness were suggestive of GBS. The cornerstone treatments involve hospitalization to facilitate continuous monitoring for serious sequelae, such as acute respiratory failure and cardiac dysrhythmia, followed by immunotherapy with IVIG or plasma exchange. Gait disturbance and weakness in a child is a diagnostic challenge. GBS is the most common cause of acute paralysis in the Western world and should remain high on the clinician\u2019s differential diagnosis. However, patients with GBS may also present nonclassically with extremity pain and cranial nerve palsies.\n                  <\/jats:p>","DOI":"10.1177\/2333794x19865858","type":"journal-article","created":{"date-parts":[[2019,7,24]],"date-time":"2019-07-24T11:39:06Z","timestamp":1563968346000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Bumbling, Stumbling, Fumbling: Weakness, Steppage Gait, and Facial Droop in a 3-Year-Old Male"],"prefix":"10.1177","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8968-3183","authenticated-orcid":false,"given":"Aviva J.","family":"Whelan","sequence":"first","affiliation":[{"name":"University of Illinois College of Medicine at Peoria, Peoria, IL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdullah","family":"Tolaymat","sequence":"additional","affiliation":[{"name":"University of Illinois College of Medicine at Peoria, Peoria, IL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shane C.","family":"Rainey","sequence":"additional","affiliation":[{"name":"University of Illinois College of Medicine at Peoria, Peoria, IL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2019,7,24]]},"reference":[{"key":"bibr1-2333794X19865858","doi-asserted-by":"publisher","DOI":"10.1542\/pir.18-1-10"},{"key":"bibr2-2333794X19865858","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.36.607"},{"key":"bibr3-2333794X19865858","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1114525"},{"key":"bibr4-2333794X19865858","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.56.6.758"},{"key":"bibr5-2333794X19865858","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(97)12308-X"},{"key":"bibr6-2333794X19865858","doi-asserted-by":"publisher","DOI":"10.3329\/jhpn.v28i6.6602"},{"key":"bibr7-2333794X19865858","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.51.4.1110"},{"key":"bibr8-2333794X19865858","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199204233261706"},{"key":"bibr9-2333794X19865858","doi-asserted-by":"publisher","DOI":"10.1177\/088307389601100102"},{"key":"bibr10-2333794X19865858","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e31820e7b62"},{"key":"bibr11-2333794X19865858","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-981686"},{"key":"bibr12-2333794X19865858","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199303000-00023"},{"key":"bibr13-2333794X19865858","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410270707"},{"key":"bibr14-2333794X19865858","first-page":"25","volume":"3","author":"Alkan O","year":"2009","journal-title":"J Radiol Case Rep"},{"key":"bibr15-2333794X19865858","doi-asserted-by":"publisher","DOI":"10.1016\/j.pedneo.2012.07.003"},{"key":"bibr16-2333794X19865858","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2004.065706"},{"key":"bibr17-2333794X19865858","doi-asserted-by":"publisher","DOI":"10.1007\/s10875-010-9407-4"},{"key":"bibr18-2333794X19865858","doi-asserted-by":"publisher","DOI":"10.3109\/00365549509019016"},{"key":"bibr19-2333794X19865858","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2004-1324"},{"issue":"9","key":"bibr20-2333794X19865858","first-page":"CD002063","author":"Hughes RA","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"bibr21-2333794X19865858","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD001798.pub3"},{"key":"bibr22-2333794X19865858","doi-asserted-by":"publisher","DOI":"10.1136\/adc.74.4.281"}],"container-title":["Global Pediatric Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2333794X19865858","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/2333794X19865858","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2333794X19865858","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:09:14Z","timestamp":1777446554000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/2333794X19865858"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1]]},"references-count":22,"alternative-id":["10.1177\/2333794X19865858"],"URL":"https:\/\/doi.org\/10.1177\/2333794x19865858","relation":{},"ISSN":["2333-794X","2333-794X"],"issn-type":[{"value":"2333-794X","type":"print"},{"value":"2333-794X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,1]]},"article-number":"2333794X19865858"}}