Contemporary thinking implicates a fundamental failure of T regulatory cell function in GCA pathophysiology, representing opportunity for novel therapeutic avenues. Tocilizumab has become the first Food and Drug Administration-approved treatment for GCA following demonstration of efficacy and safety in a phase 3 clinical trial. There have been significant parallel advances in both our understanding of GCA pathophysiology and treatment. Tocilizumab, and other agents currently under investigation in phase 2 and 3 clinical trials, presents a new horizon of hope for both disease remission and avoidance of glucocorticoid-related complications.
Palatal tremor (PT) (or myoclonus) is a rare movement disorder comprising 2 forms: essential PT (EPT) and symptomatic PT (SPT). c The rhythmic movement of the PT may be unilateral or bilateral with partial or complete rhythmicity. During sleep, tremor ceases in EPT but not in SPT. c Treatment for SPT includes medication such as valproate, clonazepam, or trihexyphenidyl; botulinum toxin has been successful in only a few reported cases. Oysters c Examination of the palate and careful review of imaging should be done in patients who present with progressive ataxia to recognize the clinical syndrome of progressive ataxia and PT. c MRI may demonstrate olivary pseudohypertrophy with contrast enhancement in PT and should not be confused with malignancy or stroke.
Objective:
To assess the demographic characteristics and presenting symptoms of a cohort of children who were admitted with ischemic stroke and develop a modification of an adult stroke recognition tool that would applicable to pediatric population.
Method:
We conducted a retrospective medical record review of all children aged 1 month to 18 years with radiologically confirmed ischemic stroke who were admitted to the University of Kentucky between January 2013-December 2017. Age, sex, race, presenting symptoms, stroke etiology and discharge disposition were recorded. The FAST mnemonic (Face, Arm, Speech) was applied to all patients.
Results:
There were 38 children with ischemic stroke (89% Caucasian, 73% boys). The strokes were most commonly associated with traumatic (28%) followed by intracranial infection (21%). FAST accurately identified 21 of stroke patients (61%), but only 35.7% of the children < 3 years of age. The addition of new onset seizures to FAST (FAST-S) increased overall sensitivity to 78.9% and to 100% in the 1month - 3 years’ age group.
Conclusions:
Unlike adults, the most common causes of pediatric stroke in our cohort were trauma and infection. FAST is not sensitive in the pediatric population, particularly in children <3-years old. The addition of new onset seizures in children to FAST improves stroke identification.
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