Intracranial hypertension is a rare entity in prepubertal children, and its differential diagnosis includes a number of systemic diseases, drugs, vitamin deficiencies and excesses, and hereditary conditions. Infectious aetiology is rare. The case of a 9-year-old boy with intracranial hypertension secondary to acute neuroborreliosis is described. He presented with daily pulsatile frontotemporal headache, pallor, photophobia and phonophobia. His neurological examination revealed papilledema with no nuchal rigidity. The lumbar puncture showed increased pressure (50 cm HO) and lymphocytic pleocytosis. Serum and cerebrospinal fluid (CSF) antibodies were positive. This kind of infection is rare in Portugal but a trip to an endemic area was identified. A careful history, considering the exposure to rural areas together with the intracranial hypertension and inflammatory CSF, are important clues to the diagnosis, allowing the institution to select appropriate treatment.
A trombocitopenia aloimune neonatal é das principais causas de trombocitopenia grave no recém-nascido, estimando-se que afete um em 1000-10000 nados vivos, estando provavelmente subdiagnosticada. Deve-se à transferência placentar de anticorpos maternos contra antigénios presentes nas plaquetas do feto mas ausentes nas plaquetas da mãe. A trombocitopenia é de início precoce, podendo ser grave com complicações como a hemorragia intracraniana, que pode ocorrer antes ou após o nascimento. Descreve-se o caso de um recém-nascido filho de pais naturais da China com uma trombocitopenia grave de início precoce de causa aloimune por incompatibilidade do antigénio HPA-3b. Esta é uma causa rara de trombocitopenia aloimune (os antigénios mais frequentes são o HPA-1a e HPA-5b), com poucos casos descritos na literatura. O diagnóstico colocou dificuldades acrescidas, uma vez que os anticorpos maternos são lábeis, tendo a genotipagem plaquetária sido importante para o esclarecimento da incompatibilidade.
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