Coskun Yarar

Relapsing Acute Disseminated Encephalomyelitis in Children: Further Evaluation of the Diagnosis

We examined our cases of relapsing acute disseminated encephalomyelitis (n = 13) in which diagnosis was made before the publication of the International Pediatric Multiple Sclerosis Study Group criteria in 2007, with the aim of reevaluating the primary diagnosis, examining any features indicative of other disorders, and determining the final diagnosis. Mean duration of follow-up was 9.4 (range, 2-20) years. Most (n = 11) were multiphasic, and 2 were recurrent cases. The final diagnosis changed in only 2 patients, both in the multiphasic group: one multiple sclerosis, and one other possible central nervous system vasculitis. All others are still being followed up as relapsing acute disseminated encephalomyelitis and had no further attacks. Six patients in this category did not have encephalopathy at first episode, which suggested the requirement for encephalopathy might be restrictive for certain cases. These results suggest the diagnosis of relapsing acute disseminated encephalomyelitis can be made correctly in most cases by clinical and imaging features.

Magnetic resonance imaging at first episode in pediatric multiple sclerosis retrospective evaluation according to KIDMUS and lesion dissemination in space criteria

BACKGROUND Several diagnostic imaging criteria are being described and examined in pediatric multiple sclerosis (MS). Compared to adults, children are more likely to experience acute or relapsing demyelinating episodes of various etiologies which show similar clinical and magnetic resonance imaging (MRI) findings. AIM To investigate the fulfillment of MRI diagnostic criteria at initial episode in pediatric MS. METHODS We reviewed our series of children and adolescents with the final diagnosis of clinically definite MS and applied the McDonald dissemination in space (DIS) and KIDMUS criteria to their initial MRI scans. RESULTS Thirty patients (17 girls, 13 boys), most with brainstem dysfunction and polysymptomatic presentation, were included in the study. Twenty-five (83.3%) patients fulfilled both McDonald and KIDMUS criteria. Patients who did not meet any McDonald DIS criteria did not meet KIDMUS criteria either. Only one patient met the McDonald criteria but not the KIDMUS criteria because of the absence of lesions perpendicular to corpus callosum. CONCLUSIONS Our results show 5/30 (16.6%) of MS patients may not present the diagnostic MRI features initially. The variable sensitivity observed for the current MRI criteria in different series can be due to referral biases, differences between populations and length of follow-up, and the definition of MS patients by two attacks only.

Akathisia in association with herpes simplex encephalitis relapse and opercular syndrome in children

We report a 2-year-old boy with herpes simplex virus type 1 encephalitis (HSE) and opercular syndrome who presented with clinical relapse characterized by chorea-like involuntary movements that suggest akathisia. The patient initially presented with multiple focal seizures that cause epilepsia partialis continua, polymerase chain reaction (PCR) for herpes simplex virus type 1 was positive. He developed hypersalivation, speech and swallowing difficulties within 30days. Based on these findings the patient was diagnosed as having opercular syndrome due to HSE. He developed akathisia on 44th day of admission as a relapse and he was successfully treated with propranolol. Opercular syndrome might be seen HSE in children and it may cause neurological suquela. Akathisia might be seen after encephalitic process as a symptom of relapse, however diagnosis of akathisia is difficult in young children. It should be noted that because propranolol effective for these involuntary movements. It can be add additional choice of treatment in these patients.

Management of vertigo in children

Çocukluk çağında vertigo ender görülen bir yakınmadır. Çocukluk döneminde vertigo sıklığı %5,7 olarak bildirilmiştir. Çocukluk çağında baş dönmesi sıklığı değerlendirilirken küçük çocukların baş dönmesini sözel olarak söyleyemeyebileceği ve daha önceden bilmedikleri bu duruma ağlayarak, korkarak tepki gösterebileceği dikkate alınmalıdır. Vertigoda dönme hareketi söz konusudur. Sersemlik, kendini kötü hissetme benzeri yakınmalar vertigo olarak kabul edilmemelidir. Vertigo santral veya periferik nedenlerden kaynaklanabilir. Çocuklarda benign paroksismal vertigo, vestibüler migren en sık vertigo nedenleridir. Çocukluk çağı baş dönmesi yakınmasıyla başvuran bir hastanın değerlendirmesinde ilk aşamada olayın akut ve tekrarlayan olup olmadığı, başlama zamanı, şiddeti belirlenmelidir. Hastaların fizik ve nörolojik muayeneleri yanı sıra odyolojik değerlendirmeleri de gereklidir. Tedavi planlaması altta yatan nedene göre yapılmalıdır.