Jatinder S. Goraya

Persistence of breath-holding spells into late childhood.

Breath-holding spells commonly occur during infancy. The disorder represents a self-limited, benign phenomenon, and breathholding spells almost always resolve by school age. Their continuing occurrence beyond this age is exceedingly uncommon and may create diagnostic confusion. We recently encountered an 8-year-old boy who continues to experience breath-holding spells. (J Child Neurol 2001;16:697-698).

An unusual case of neonatal brain abscess following Klebsiella pneumoniae septicemia

A case of solitary brain abscess in a term neonate caused by Klebsiella pneumoniae is described: K. pneumoniae, although a common cause of neonatal septicemia, is rarely implicated as an etiological agent for cerebral abscess in this age-group. The interest of this case lies in the rarity of the causative organism and atypical features. In the absence of predisposing factors in the neonate, we suspect that the infection was transmitted vertically from the mother before or at the time of delivery since there was evidence of asymtpomatic urinary tract infection in the antenatal period.

Hyperekplexia in a girl with posterior fossa malformations.

Hyperekplexia is a rare clinical syndrome of pathologic startle response to unexpected stimuli such as sound or touch. The majority of cases are familial. Sporadic cases of hyperekplexia have also been reported, mostly in association with brainstem pathology. We describe a girl with sporadic hyperekplexia secondary to previously unreported cerebellar pathology. Her symptomatology was predominantly unilateral, being ipsilateral to the cerebellar involvement. This type of presentation, which may be termed hemihyperekplexia, has not been described before. Response to clonazepam was good but showed diurnal variations. The case is being reported for its unusual features. (J Child Neurol 2002;17: 147-149).

Recurrent Nocturnal Tongue Biting in a Child With Hereditary Chin Trembling

A 13-month-old boy presented with repeated episodes of tongue biting during sleep. On evaluation, he was found to have hereditary chin trembling, a rare autosomal dominant condition characterized by continuous or intermittent tremulous activity of the mentalis muscle. This is the first report of this kind from India. The tongue biting appeared to be the result of parasomnia. Treatment with clonazepam was very effective; it completely ameliorated the symptom of tongue biting but had no effect on chin trembling. (J Child Neurol 2006;21:985—987; DOI 10.2310/ 7010.2006.00220).

Neonatal transfusion malaria requiring exchange transfusion.

Abstract Transfusion-acquired malaria in a neonate is uncommon and factors such as drug resistance and concomitant G6PD deficiency can cause treatment difficulties. We report a 26-day-old premature infant with chloroquine-resistant malaria who underwent exchange transfusion. The aim was to correct anaemia, decrease parasitaemia and remove G6PD-deficient cells to allow successful use of quinine.

Pellagrous dermatitis induced by phenytoin.

1. Millard T, Harris A, MacDonald D. Acute infantile hemorrhagic edema. J Am Acad Dermatol 1999;41:837±839. 2. Legrain V, Lejean S, Taieb A, Guillard JM, Battin J, Maleville J. Infantile acute hemorrhagic edema of the skin: study of ten cases. J Am Acad Dermatol 1991;24:17±22. 3. Gonggryp LA, Todd G. Acute hemorrhagic edema of childhood (AHE). Pediatr Dermatol 1998;15:91±96. 4. Amitai Y, Gillis D, Wasserman D, Kochman RH. Henoch±SchoÈ nlein purpura in infants. Pediatrics 1993;92: 865±867. 5. Dubin BA, Bronson DM, Eng AM Acute hemorrhagic edema of childhood: an unusual variant of leukocytoclastic vasculitis. J Am Acad Dermatol 1990;23:347±350. 6. Wilson CB, Lewis DB, Penix LA. The physiologic immunode®ciency of immaturity. In: Steim ER, ed. Immunologic disorders in infants and children. Philadelphia: WB Saunders, 1996.

Unusually severe ABO hemolytic disease of newborn.

ABO-hemolytic disease of newborn (ABO-HDN) is a common cause of neonatal hyperbilirubinemia. Most of the cases are however mild. We desribe a neonate with ABO-HDN with unusually severe course.

ACUTE LYMPHOBLASTIC LEUKEMIA PRESENTING AS CYCLIC NEUTROPENIA

Clinical and laboratory parameters usually allow an easy diagnosis of acute lymphoblastic leukemia in most cases. Difficulty arises, however, when presentation is atypical. A young child with membranous tonsillo-pharyngitis secondary to an isolated neutropenia is reported. The neutrophilic count later showed fluctuations reminiscent of cyclic neutropenia. Bone marrow examination revealed the true nature of underlying disorder.

Late-onset or persistent febrile seizures.

8. Chabrier S, Rodesch G, Lasjaunias P, et al: Transient cerebral arteriopathy : A disorder recognized by serial angiograms in children with stroke. J Child Neurol 1998;13:27-32. 9. Calabrese LH, Furlan AJ, Gragg LA, Ropos TJ: Primary angiitis of the central nervous system: Diagnostic criteria and clinical approach. Cleve Clin JMed 1992;59:293-306. 10. Calabrese LH, Gragg LA, Furlan AJ: Benign angiopathy: A distinct subset of angiographically defined primary angiitis of the central nervous system. J Rheumatol 1993;20:2046-2050.

Hypospadias-hypertelorism syndrome

A young male child presented with hypospadias. Examination revealed additional anomalies including hypertelorism and upslanting of palpebral fissures, suggesting a diagnosis of hypospadias-hypertelorism syndrome. The case is reported because of its rarity and some unusual features.