Empyema thoracis, is a rare cause of respiratory distress in neonates. Only a few cases of neonatal empyema thoracis are described in medical literature. Empyema thoracis is not a well known entity in the neonates. It is fulminant with rapid progression with a high mortality. Compounding the problem is its uncertain etiopathogenesis and lack of definite treatment guidelines. We shall describe one case of neonatal empyema in a newborn aged five days caused by Pseudomonas aeruginosa. The neonate died subsequently.
Cardiovascular abnormality is the most consistent finding and occur in almost 80 % of all Williams syndrome (WS). Although a number of cardiovascular defects are common to WS, the majority presents in some form of arterial stenosis whereas supravalvular aortic stenosis is the most common one. Here we describe a 12 year old boy with elfin facies, presenting with urinary incontinence and a systolic murmur in right upper parasternal region. Echocardiography showed presence of double chambered right ventricle (DCRV) along with supravalvular aortic stenosis (SVAS) and coronary artery aneurysms, left pulmonary artery stenosis and multiple bladder diverticula in CT abdomen. With the clinical suspicion the diagnosis of WS was made and confirmed by fluorescent in situ hybridisation (FISH) study showing deletion in 7q11.23. Though different forms of arterial stenosis at multiple sites have been demonstrated in WS, DCRV in Williams syndrome is not reported till date in medical literature.
Eye movement abnormalities always clench the eyes of a neurologist to reach an interesting diagnosis most of the time in children. The common etiologies affecting the complex brainstem pathways and frontal eye field controlling conjugate eye movement are childhood stroke (pontine infarct), demyelinating disorders, mass lesions, trauma and metabolic or mitochondrial diseases. Horizontal eye movements are conducted by the medial rectus and the lateral rectus muscles. Medial rectus is innervated by oculomotor nerve (cranial nerve III) and the lateral rectus is innervated by abducens nerve (cranial nerve VI) respectively. The oculomotor and the abducens nuclei are interconnected by medial longitudinal fasciculus (MLF). The disorders of horizontal eye movement that are caused by brainstem lesions are classified into three groups: lateral gaze palsy, internuclear ophthalmoplegia, and one-and-a-half syndrome. In the present study, three interesting cases with gaze palsy have been taken into account. Case 1 is an 8-year-old boy presented with left sided hemiparesis and right sided gaze palsy with loss of adduction in right eye (One-and-half syndrome). MRI showed large areas of increased T2W signal intensity both in subcortical white matter and brain stem (involving abducens nucleus, PPRF and ipsilateral MLF). Case 2 is also of a 10-year-old boy, diagnosed to be a case of Clinically Isolated Syndrome (CIS) with ataxia and ophthalmoplegia. MRI showed areas of sub-cortical demyelination in both fronto-parietal region (right side more involved than left) with brain stem and cerebellum unaffected. Case 3 is about an 18-month-old boy presented with complete ophthalmoplegia (Inability to move both the eyes with absent conjugate movement in all directions) and delayed developmental milestones. Lactate was raised in venous blood and MRI showed necrosis in basal ganglia (thalami) and brain stem, with MR spectroscopy showed double lactate peak consistent with Leigh disease (mitochondrial encephalomyopathy).
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