Vol 12, No 4 (2017)

Alalia is a speech disorder that develops due to organic brain damage in children with normal hearing and intelligence during the first three year of life. Systemic speech underdevelopment in alalia is characterized by violations in the phonetic, phonemic, lexical, and grammatical structure. Patients with alalia can also have non-speech related impairments, including motor (impaired movement and coordination), sensory (impaired sensitivity and perception), and psychopathological disorders. There are three types of alalia: motor, sensory, and mixed. Children with motor alalia have expressive language disorders, speech praxis, poor speech fluency, impaired articulation, and other focal neurological symptoms; however, they understand speech directed to them. Patients with motor alalia are often left-handed. Regional slowing and epileptiform activity are often detected on their electroencephalogram.  Children with sensory alalia are characterized by poor speech understanding (despite normal hearing) resulting in secondary underdevelopment of their own speech. These patients have problems with the analysis of sounds, including speech sounds (impaired speech gnosis), which prevents the development of association between the sound image and the object. Therefore, the child hears, but does not understand the speech directed at him/her (auditory agnosia). Differential diagnosis of alalia is challenging and may require several months of observation. It also implies the exclusion of hearing loss and mental disorders.

Congenital deficiency of vitamin B12 in children is a frequent metabolic disorder in pediatric practice. The disease has multiple symptoms, including various somatic and nervous manifestations. The main symptom of vitamin B12 deficiency is the regression of psychomotor development with significant trophic impairments and changes in the internal organs. Without substitution therapy with vitamin B12, these children quickly develop irreversible disorders that can lead to death, whereas timely parenteral administration of vitamin B12 can ensure the restoration of the initial development level. We describe a patient aged 1 y. o. 4 months, who was diagnosed with vitamin B12 deficiency anemia and general vitamin B12 deficiency at the age of 8 months; as a result, the child developed various paroxysms that were considered to be epileptic. The patients started to receive vitamin B12 and antiepileptic drugs, which helped to achieve clinical remission with normal psychomotor development.

Neuromyelitis optica spectrum disorder is an inflammatory demyelinating disease of the central nervous system with selective damage to the optic nerves and spinal cord. The clinical case of a child 11 years old and its course throughout the year, with an onset in the form of an episode of visual impairment with signs of a previously developed partial atrophy of the optic nerves of both eyes and a manifestation of retrobulbar neuritis on the left eye is considered in the article. Repeatedly conducted magnetic resonance examination revealed a pattern of focal lesion of the left and then of the right optic nerve with a violation of the integrity of the blood brain barrier and an extended focus in the structure  of the spinal cord of the cervical spine. The blood test for antibody to aquaporin-4 was positive. Optical coherence tomography revealed decrease in the thickness of the peripapillary fibers of the retina in all quadrants in both eyes, which indicates a partial atrophy of the optic nerves  of both eyes, as a result of repeatedly transferred retrobulbar neuritis in both eyes.

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