-Acute transverse myelitis is an acute inflammatory process of the spinal cord and it is a rare clinical syndrome in childhood. In this paper, we report a case of 3 years-old boy who developed acute onset tetraparesia following a viral respiratory infecction and hepatitis B vaccination. Magnetic resonance imaging of the spinal cord disclosed signal-intensity abnormalities from C4 to C3. A diagnosis of acute transverse myelitis was made and the patient was treated with IV methylprednisolone and IV immunoglobulin. The child had a fair outcome despite of the very acute course of the disease and the presence of a cervical sensory level which usually harbor a poor prognosis.KEY WORDS: acute transverse myelitis, childhood, hepatitis B vaccination, respiratory infection.Mielite transversa aguda de início precoce precedida de vacinação para hepatite B e infecção viral Mielite transversa aguda de início precoce precedida de vacinação para hepatite B e infecção viral Mielite transversa aguda de início precoce precedida de vacinação para hepatite B e infecção viral Mielite transversa aguda de início precoce precedida de vacinação para hepatite B e infecção viral Mielite transversa aguda de início precoce precedida de vacinação para hepatite B e infecção viral respiratória: relato de caso. respiratória: relato de caso. respiratória: relato de caso. respiratória: relato de caso. respiratória: relato de caso.RESUMO -----A mielite transversa aguda é processo inflamatório agudo da medula espinhal de ocorrência rara na infância. Neste artigo, reportamos o caso de um menino de 3 anos que desenvolveu tetraparesia aguda precedida de infecção viral respiratória e pós-vacinação para Hepatite B. A imagem pela Ressonância Magnética da medula espinhal revelou anormalidade de aumento de sinal em C4-T3. Após o diagnóstico da mielite transversa aguda, o paciente foi tratado com metilprednisolona e imunoglobulina. Embora a doença tenha se apresentado de forma aguda e acompanhada de nível sensitivo, o que usualmente levaria a um prognóstico sombrio, a criança evoluiu favoravelmente, PALAVRAS-CHAVE: mielite transversa aguda, infância, vacinação, hepatite B, infecção viral respiratória.
Among the various types of pigmentary disturbances associated with mosaicism, the phylloid pattern (Greek phyllon = leaf, eidos = form) is characterized by multiple leaf-like patches reminiscent of an art nouveau painting. The number of cases displaying this unusual pattern is so far limited. We describe a phylloid pattern of hypomelanosis in a 3-year-old girl with multiple congenital anomalies including microcephaly, midfacial hypoplasia, cleft lip, coloboma, posteriorly rotated ears, pectus carinatum, and pronounced mental and physical retardation. In addition, this child had oval or oblong patches of hyperpigmentation involving the trunk in a horizontal arrangement dissimilar from the phylloid hypomelanotic pattern. In peripheral blood lymphocytes a karyotype 46,XX,-13,+t(13q;13q) was consistently found, whereas cultured skin fibroblasts showed a complex form of mosaicism comprising three different abnormal cell lines (46,XX,-13,+t(13q;13q)/45,XX,-13/45,XX,-13,+frag). This case provides further evidence that the phylloid pattern represents a separate category of pigmentary disturbance to be distinguished from other types of cutaneous mosaicism such as the lines of Blaschko or the checkerboard arrangement.
Among the various types of pigmentary disturbances associated with mosaicism, the phylloid pattern (Greek phyllon = leaf, eidos = form) is characterized by multiple leaf-like patches reminiscent of an art nouveau painting. The number of cases displaying this unusual pattern is so far limited. We describe a phylloid pattern of hypomelanosis in a 3-year-old girl with multiple congenital anomalies including microcephaly, midfacial hypoplasia, cleft lip, coloboma, posteriorly rotated ears, pectus carinatum, and pronounced mental and physical retardation. In addition, this child had oval or oblong patches of hyperpigmentation involving the trunk in a horizontal arrangement dissimilar from the phylloid hypomelanotic pattern. In peripheral blood lymphocytes a karyotype 46,XX,-13,+t(13q;13q) was consistently found, whereas cultured skin fibroblasts showed a complex form of mosaicism comprising three different abnormal cell lines (46,XX,-13,+t(13q;13q)/45,XX,-13/45,XX,-13,+frag). This case provides further evidence that the phylloid pattern represents a separate category of pigmentary disturbance to be distinguished from other types of cutaneous mosaicism such as the lines of Blaschko or the checkerboard arrangement.
In studies about cerebral infarcts in children, despite many different methodologic approach, a common observation is the wide diversity of etiologies. According to the Pan American Health Organization, in the last decade the mortality rate for Brazilian children under one year was 6 times higher than the rates reported by developed countries 1 . We hypothesized that the high morbidity condition of the disease in Brazil is a consequence of distinctive characteristics in the distribution of the causes of cerebral infarcts.Thus, the objective of the present investigation was to identify cerebral infarcts in children aged zero to 15 years attended at a tertiary hospital, ABSTRACT -Cerebral infarcts in children present peculiar characteristics either due to their diversity of causes or due to the unknown nature of the causes. The etiologies of cerebral infarct were reviewed in children from zero to 15 years old, attended at a tertiary hospital, in Ribeirão Preto (Brazil), from 1990 to 1997, adopting the modified Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria of classification; 1 -Atherosclerosis in large arteries; 2 -Cardioembolic; 3 -Occlusion of small vessels; 4 -Other etiologies; 5 -Undetermined cause. Thirty-nine children were included, 18 males and 21 females, aged 2 months to 15 years, mean age 5.67. The largest group, N=22 (56.4%), included children with "other etiologies", 7 of them aged under two years. The most common etiology was dehydration and septic shock leading to brain hypoperfusion and watershed infarcts. Nine (23%) children had "Undetermined etiology", 7 (17,9%) cardioembolic subtype and none had atherosclerosis. Laboratory improvement is needed for the large number of patients without a defined cause, and the high proportion of children with dehydration in the group with a determined cause emphasizes the need for preventive health actions among infants and children. CEREBRAL INFARCT IN CHILDREN AGED ZERO TO FIFTEEN YEARSKEY WORDS: cerebrovascular disease, cerebral infarct, stroke, children, infants, etiology. Infarto cerebral em crianças de zero a quinze anos de idadeRESUMO -Infartos cerebrais em crianças apresentam peculiaridades, como grande variedade de causas e alta freqüência sem etiologia definida. Foram revistos os diagnósticos etiológicos em crianças de zero a 15 anos, atendidas durante o ictus e com imagens cerebrais sugestivas de infarto, entre 1990 e 1997 em hospital terciário de Ribeirão Preto (SP). Adotou-se o critério de classificação modificado do Trial of ORG 10172 in Acute Stroke Treatment (TOAST): 1 -Arterioesclerose de grandes artérias, 2 -Cardioembólico, 3 -Oclusão de pequenos vasos, 4 -Outras etiologias, 5 -Não determinada. Trinta e nove crianças foram incluídas, 18 do sexo masculino e 21 do feminino, com idade variando entre 2 meses e 15 anos e média de 5,67. O maior grupo, com 22 crianças (56,4%), foi o de "Outras etiologias", 7 das quais com idades entre 2 meses e um ano. A etiologia mais freqüente foi desidratação e choque séptico, levando a hipoperfusão ce...
Autism is a behavioral severe disorder characterized by a start within 36 months of age, with symptoms in the areas of interpersonal interaction, communication, and behavior. It presents three forms of evolution: always with delay in psychic development, loss of some acquired skill on the basis of a delay in development (partial regression), and full regression. Objective: to research the frequency of each form of evolution. Methods: longitudinal study in a tertiary pediatric public hospital in an outpatient Developmental Disorders Clinic, during 20 months, with the first appointment within 48 months of age. The DSM-IV and the CARS and DSM-IV scales were used as diagnostic criteria; questions were asked about regressions and delays in development or not in the initial development of autism. Results: of the 86 children with clinical signs and positive scales for autism, 74.4% always showed delays in development, 17.4% showed a history of delays in development with some degree of regression, and only 8.1% presented a history of full regression. Conclusion: all children with a history of permanent delay in the milestones of psychic development should have autism as the diagnostic hypothesis.
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