The clinical and radiographic findings of 68 children and adolescents with nontraumatic intraparenchymal brain hemorrhage were analyzed retrospectively. There were 43 boys and 25 girls, and the average age was 7.1 years (range, 3 months to 18 years). The most common presenting symptom was a combination of headache or vomiting (40 cases, or 58.8%). Hemiparesis was the major presenting sign in 11 (16.2%) of the children, seizures occurred in 25 (36.8%) patients, and 6 (8.8%) children were irritable. Only 2 (2.9%) children were comatose at presentation. One or more risk factors for hemorrhage were found in 61 (89.7%) of 68 children. A third (23 cases, or 33.8%) had an arteriovenous malformation or fistula; altogether 29 (42.6%) children had some type of congenital vascular anomaly. Hematologic or coagulation disorders were present in 22 (32.4%) patients, and 9 (13.2%) patients had brain tumors. Hemorrhage could not be attributed to systemic hypertension in any child. The likelihood of establishing the cause of bleeding was greater when evaluation included cerebral angiography (97.3% versus 80.4% without angiography). Half (34 cases, or 50.0%) of the patients regained normal neurologic function. Six (8.8%) patients died, either directly or partly as a consequence of the hemorrhage. The remaining patients had various neurologic sequelae, including 17 (25.0%) with hemiparesis, 5 (7.4%) with aphasia, 7 (10.3%) with epileptic seizures, and 3 (4.4%) with hydrocephalus. More detailed follow-up studies are needed to obtain more information about the frequency of cognitive sequelae.
SUMMARY Of 215 Saudi children seen with their first febrile convulsion (FC) at the King Khalid University Hospital, Riyadh, between January 1984 and December 1988, the index FC was simple for 133 children and complex for the remaining 82. History of adverse antecedent factors, particularly perinatal asphyxia, birth injuries and pre‐existing neurological deficits, were significantly more associated with complex FC, as was occurrence of first FC before the age of 12 months. Recurrence of FCs and development of epilepsy were also more common among the group of children with complex FC. Complex FCs were less benign in the present study population than has been reported in some Western studies. RÉSUMÉ Antécédents et devenir des convulsions fébriles simples et complexes farmi les enfants saoudiens Parmi 215 enfants saoudiens avec une première convulsion febrile (FC) vus au King Khalid University. Hospital de Riyadh entre Janvier 1984 et decembre 1988, l'index (FC) fut simple pour 133 enfants et complexe pour les 82 restants. L'histoire de facteurs extérieurs défavorables notamment une asphyxie périnatale, des lésions à la naissance et des déficits neurologiques pré‐existants était significativement davantage associée avec des FC complexes, lorsque la première FC se situait avant l'âge de 12 mois. La récidive des FC et le développement d'une épilepsie étaient également plus fréquents dans le groupe des enfants avec FC complexes. Les FC complexes sont apparus moins bénignes dans l'étude de population présente qu'il n'avait été rapporté dans quelques études occidentales. ZUSAMMENFASSUNG Initialsymptome und Verlauf einfacher und komplexer Fieberkrämpfe bei saudischen Kindern Von 125 saudischen Kindern, die im König Khalid Universitätskrankenhaus in Riad von Januar 1984 bis Dezember 1988 wegen ihres ersten Fieberkrampfes (FC) behandelt wurden, hatten 133 einen einfachen und die restlichen 82 einen komplexen Fieberkrampf. Bei Kindern mit komplexem FC fanden sich in der Anamnese signifikant häufiger pathologische Vorbefunde, wie perinatale Asphyxie, Geburtsverletzungen und schon bestehende neurologischen Störungen, sowie sie häufiger ihren ersten FC im ersten Lebensjahr hatten. Rekurrierende FCs und Entwicklung von Epilepsie waren bei den Kindern mit komplexem FC ebenfalls häufiger. Die komplexen FCs waren bei den hier untersuchten Kindern weniger gutartig als dies in einigen westlichen Untersuchungen dargestellt wurde. RESUMEN Antecedentes y curso posterior de las convulsiones febriles simplesy complejas en niños de Arabia Saudi De 215 niños Saudies vistos por su primera convulsion febril (CF) en el Hospital Universitario Rey Khalid en Riyadh entre enero de 1984 y diciembre de de 1988, 133 tenían una CF simple y el resto de 82 la tenían compleja. Una historia de factores antecedentes adversos, en especial asfixia perinatal, lesiones del parto y deficits neurológicos preexistentes estaban mas asoctados signoficativamente con CF complejas asi como la aparición de la primera CF antes de los 12 meses de edad. La reiteración de l...
The study describes the pattern of childhood neuromuscular disorders seen in a decade (1982-1992) at King Khalid University Hospital, Riyadh, Saudi Arabia. Similar data are scanty outside Europe and North America, and lacking in Saudi Arabia. Eighty-four children (< or = 16 years) were assigned to an entity of neuromuscular disease following review of the clinical, biochemical and neurophysiological data, and after re-examination of the histological and histochemical features of the muscle biopsies. Of the 84 ascertained cases, 40 (48%) had different forms of muscular dystrophy (MD), 26 (31%) had one of the various types of spinal muscular atrophy (SMA) and two (2.4%) hereditary motor and sensory neuropathy type I. The rest were miscellaneous cases including one (1.2%) with dermatomyositis. Of the dystrophies, severe childhood autosomal recessive muscular dystrophy (SCARMD) was more prevalent (30%) than Duchenne type (25%), conforming with observations from North African countries known to have a high incidence of consanguineous marriages. Family history of other cases of SCARMD included three males and three females, one of whom died at 15 years, and consanguinity was evident in 63%. Congenital MD, inherited in an autosomal recessive pattern, was also common (30%). A history of consanguinity was present in 55%. Of the 26 cases of SMA, type I (Werdnig-Hoffman disease) was the most prevalent (69%). Consanguinity was ascertained in 65% of SMA families and histories revealed another 14 affected siblings. Autosomal recessive forms seem to constitute the bulk of neuromuscular disorders in Saudi Arabia.
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