Ozan Kocak

Evaluation of Pediatric Stroke Patients

Objective: Childhood stroke is common than expected due to increased availability of imaging studies. We aim to evaluate clinical and radiologic findings of stroke. Method: In this study 23 children (15 boys, 8 girls) aged 3 months to 17 years were included. Clinical findings and etiologic causes of the patients with radiologic confirmed stroke and treatment options are considered. Result: Clinical signs of our patients include hemiparesis, seizure, speech disturbance, headache, facial nerve palsy, confusion, cerebellar signs, syncope, visual field defect, headache. Most frequent presenting symptoms are hemiparesis and seizure. Conclusion: In our study most frequent risk factors are prothrombic states, infection, vasculopathy, cardiac disease, trauma, vascular malformation respectively.

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.

Viral etiological causes of febrile seizures for respiratory pathogens (EFES Study)

ABSTRACT Background: Febrile seizure is the most common childhood neurological disorder, is an important health problem with potential short- and long-term complications, also leading to economic burden and increased parental anxiety about fevers and seizures occurring in their children. There are no routine recommendation to detect etiological causes of FS for neurological perspective, further knowledge about the etiological causes of FS in children will support preventive measures and follow-up strategies. The aim of this study is to evaluate the percentage of respiratory viruses in children with FS. Methods: This prospective multicenter study, entitled “Viral etiological causes of febrile seizures for respiratory pathogens (EFES Study)” examined representative populations in eight different cities in Turkey between March 1, 2016 and April 1, 2017. Nasopharyngeal swabs were taken from all children at presentation. A respiratory multiplex array was performed to detect for influenza A and B; respiratory syncytial virus A and B; human parainfluenza virus 1-2-3 and 4; human coronavirus 229E and OC43; human rhinovirus; human enterovirus; human adenovirus; human bocavirus; human metapneumovirus. Results: During the study period, at least one virus was detected in 82.7% (144/174) of children with FS. The most frequently detected virus was adenovirus, followed by influenza A and influenza B. Detection of more than one virus was present in 58.3% of the children with FS, and the most common co-existence was the presence of adenovirus and influenza B. In children younger than 12 months, Coronavirus OC43 was the most common, while influenza A was most frequently observed in children older than 48 months (p < 0.05). Human bocavirus was common in children who experienced complex FS, while respiratory syncytial virus (RSV) A was more common in children who experienced simple FS. Influenza B virus was the most common virus identified in children who were experiencing their first incidence of FS (p < 0.05). Conclusions: This study indicates that respiratory viruses are important in the etiology of FS in children. The results show that antibiotics must be prescribed carefully in children with FS since the majority of cases are related to viral causes. Widespread use of the existing quadrivalent influenza vaccine might be useful for the prevention of FS related to the flu. Further vaccine candidates for potential respiratory pathogens, including RSV, might be helpful for the prevention of FS.

Hemi-meningitis with hemophagocytic lymphohistiocytosis.

Hemophagocytic lymphohistiocytosis (HLH) is a rare lymphoproliferative disorder. HLH may occur as a complication of Epstein-Barr virus (EBV), particularly in patients with immunodeficiencies. Herein, we describe a 16-year-old girl with neurological complications associated EBV-induced HLH. Her cerebral magnetic resonance imaging (MRI) showed contrast-enhanced axial T1-weighted images with enhancement of meningeal surface in the right hemisphere that was consistent with right hemi-meningitis. Hydrocephalus, dilated subdural spaces, delayed myelination, edema, diffuse parenchymal atrophy, calcifications, diffuse/patchy white matter abnormalities have all been previously described with HLH. To the best of our knowledge, this is the first case of hemi-meningitis associated with HLH. We suggest that clinicians should consider HLH with vascular disorders when they determine unilateral meningitis on a brain MRI.

P79 – 2622: Juvenile-onset mitochondrial protein associated neurodegeneration – Case report

Introduction Neurodegeneration with brain iron accumulation (NBIA) comprises a clinically and genetically heterogeneous group of diseases presenting with a progressive extrapyramidal syndrome and excessive iron deposition in the brain. Mutations in the C19orf12 gene were recently (2009) described as cause of NBIA (called mitochondrial membrane protein-associated neurodegeneration, MPAN). Objective We report a Turkish child diagnosed as MPAN with new mutation. Case report A previously healthy 14-year-old girl presented with progressive slowing of speech and movements, and also frequent drop attacks. Her past history and family history were unremarkable. First neurological examination revealed: hypomimia, dysarthria, echolalia, incoordination and propulsive gait. The initial brain magnetic resonance imaging (MRI) on admission was normal. Because of progressive neurologic detonation a repeat brain MRI was done after 3 years, on T2-weighted images showed low signal intensity in the globus pallidus and substantia nigra bilaterally. Because of clinical and radiological suggestion of iron deposition, the molecular analyses was done and revealed a new homozygous mutation in C19orf12 gene: p.A56LFs*6 (c.166delG) allowing the diagnosis of MPAN. In our case, lack of peripheral neuropathy, cognitive decline and neuropsychiatric symptoms and also normal EMG findings are unusual when compared to the typical course of the MPAN. This features may be related age or clinical outcome of new mutation. As presented case, initial brain MRI findings may be normal, if there is clinical suspicion of NBIA repeated brain MRI may be necessary. To the best of our knowledge, this is the first reported Turkish child who was diagnosed as MPAN. Conclusion MPAN should be considered as a differential diagnosis in patients with juvenile onset speech and gait disturbances, dystonia, parkinsonism and pyramidal signs. Patients have to be examined carefully to detect extra-motor symptoms such as neuropsychological abnormalities or optic neuropathy. Brain MRI should be evaluated for signs of iron accumulation.