Multiple sclerosis (MS) is an inflammatory, demyelinating, neurodegenerative disorder of the central nervous system (CNS) of unknown etiology. The peak onset is between age 20 and 40 years and usually affects more women than men. Although much knowledge has been achieved on the diagnosis and treatment of adult patients with MS, it remains a matter of debate and controversy in childhood. We present a case of MS in 9-year-old girl, review the current state of the knowledge on pediatric MS, and discuss the available tools for the diagnosis and treatment.
Bacterial brain abscess remain a serious central nervous system infectious disorder despite advances in neurosurgical, neuroimaging, clinical support on intensive care units, microbiological techniques and availability of new antibiotics. The successful treatment of brain abscess usually requires surgery, appropriate antibiotic therapy and eradication of the primary source. Although uncommon, brain abscesses are particularly important in the pediatric population due to its devastating potential to cause severe neurologic deficits, especially in preterm newborns. The purpose of the present report is to describe the case of a Brazilian premature neonate with pyogenic brain abscesses caused by Serratia marcescens and to discuss therapeutic and diagnostic approaches. The early suspicion, proper diagnostic measures and immediate neurosurgical consultation associated with aggressive antibiotic therapy seem to be the essentials steps on the management for those high-risk pediatric patients.
Con lito de interesses: NãoContribuição dos autores: RCAPA orientação do relato de caso. LCM relato do caso e revisão literatura. MMCMB coleta de dados e revisão literatura. RSLP coleta de dados e revisão literatura. LCV elaboração do manuscrito. The most commonly identified causes of ischemic stroke in children are cerebral arteriopathies, congenital, or acquired cardiac diseases, sickle cell disease, and thrombophilias. In children, due to the low incidence and absence of specific methods to assess and measure correctly this entity, stroke recognition is usually delayed. Case Report: A 20 months-old girl was admitted to the emergency department presenting a history of two episodes of vomits, irritability, continuous crying, and strabismus that started suddenly. On neurological assessment, it was found divergent strabismus with right medial rectus muscle palsy and reduced right pupillary reflex to light associated with instable gait. Brain magnetic resonance imaging (MRI) showed an ischemic lesion on the right pontomesencephalic region. The patient received clinical support. On the fifth day, she was discharged with a prescription of aspirin, good clinical conditions, stable gait, and persistence of the divergent strabismus. Conclusion: Posterior circulation ischemic stroke is an important cause of morbidity and mortality on pediatric population and must be remembered to avoid diagnosis delay. Contato para correspondência: Linoel Curado ValsechiDescriptors: Stroke; Children; Posterior Circulation Artery Ischemia.Introdução: O Acidente Vascular Encefálico (AVE) é caracterizado por um déficit neurológico súbito, resultado de um evento cerebrovascular. As causas mais comuns de Acidente Vascular Encefálico isquêmico em crianças são arteriopatias cerebrais; doenças cardíacas congênitas ou adquiridas; doença falciforme e trombofilias. Nas crianças, devido à baixa incidência e ausência de métodos específicos para avaliar e medir essa entidade correntemente, o reconhecimento do Acidente Vascular Encefálico é atrasado. Relato de Caso: Uma criança do sexo feminino de 1 ano e 8 meses foi admitida na Emergência apresentando história de dois episódios de vômitos, irritabilidade, choro inconsolável e estrabismo de início súbito. Ao exame neurológico apresentava estrabismo divergente com paralisia do músculo reto medial direito e redução do reflexo pupilas ao estimulo luminoso à direita, associado à marcha instável. Ressonância Magnética do encéfalo (RM) demonstrou lesão isquêmica na região pontomesencefálica à direita. A paciente recebeu suporte clinico e no quinto dia recebeu alta hospitalar com receita de aspirina, em boas condições clínicas, estabilidade da marcha e com persistência do estrabismo divergente. Conclusão: Acidente Vascular Encefálico isquêmico de circulação posterior é uma importante causa de mortalidade e morbidade na população pediátrica e deve ser lembrada para evitar o atraso no diagnóstico.
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