Stroke is a brain injury caused by the interruption of blood-flowing to part of the brain. A neonatal stroke is a disturbance in the blood supply to an infant's brain in the first 28 days of life [1]. This includes both ischemic events, which result from a blockage of vessels, and hemorrhagic events, which result when a blood vessel ruptures and bleeds. A neonatal stroke occurs in approximately 1 in 4,000 births.
Cholestatic jaundice is a common presenting feature of neonatal hepatobiliary and metabolic dysfunction. Any infant who remains jaundiced beyond age 2 to 3 weeks should have the serum bilirubin level fractionated into a conjugated (direct) and unconjugated (indirect) portion in neonates mainly undirect bilirubin. In cholestasis, the primary failure is of bilirubin excretion, resulting in excess conjugated bilirubin in the bloodstream and decreased bile salts in the gastrointestinal (GI) tract. Because of inadequate bile in the GI tract, there is malabsorption of fat and fat-soluble vitamins (A, D, E, and K), leading to vitamin deficiency, inadequate nutrition, and growth failure. Our case is interesting present in first day of life with conjugate bilirubin which made us look for differential diagnosis, no family history of metabolic disease, 1st consequently, no dysmorphic feature, admitted in NICU as case of cholecystic jaundice for farther investigation, all investigations were done, and patient sent to higher center for farther management.
Stroke is a brain injury caused by the interruption of blood-flowing to part of the brain. A neonatal stroke is a disturbance in the blood supply to an infant's brain in the first 28 days of life [1]. This includes both ischemic events, which result from a blockage of vessels, and hemorrhagic events, which result when a blood vessel ruptures and bleeds. A neonatal stroke occurs in approximately 1 in 4,000 births.
Eventration of the diaphragm is an abnormal elevation of the dome of diaphragm. It is a condition in which all or part of the diaphragm is largely composed of fibrous tissue with only a few or no interspersed muscle fibers. It can be complete or partial. Complete eventration of the right diaphragm, as seen in this adult patient, is relatively rare.
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is a rear disease in pediatric age group which constitute a unique manifestation associated with obsessive-compulsive disorder (OCD) and tic disorder in children. However, this diagnosis has carried a lot of controversies, related mainly to its management. Here we are presenting one case of PANDAS syndrome who was treated successfully with full coarse of antibiotic for 10 days, where all his symptoms disappeared completely in subsequent days including suicidal attempts. PANDAS should be considered in children with neuropsychiatric disorders (tics, obsessive behavior etc.) especially if symptoms associated within a period of infection such as febrile illness or sore throats.
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