Pongsakdi Visudhiphan

Torticollis as the Presenting Sign in Cervical Spine Infection and Tumor

This report presents five patients with cervical-area infection and four with spinal cord tumors who presented with torticollis early in the course of their illnesses. Three children were found to have osteomyelitis of the cervical spine; two, retropharyngeal abscess; two, intramedullary astrocytoma; one, extradural neuroblastoma; and one, extradural sarcoma. Though torticollis is most frequently a benign condition, its persistence or its association with other objective findings should lead to a search for an etiologic basis.

A Bleeding Syndrome in Infants due to Acquired Prothrombin Complex Deficiency A Survey of 93 Affected Infants

A bleeding syndrome due to severe prothrombin complex deficiency is reported in 93 infants. Most were breast fed (98 per cent), aged 2 weeks to 1 year and there were no serious preceding or associated diseases. Hemor rhagic diathesis, pallor and mild hepatomegaly were the major manifesta tions. The incidence of intracr nial bleeding was strikingly high (63 per cent) particularly with subdural and subarachnoid hemorrhage. Acute onset, short course and rapid clinical and laboratory improvement after vitamin K therapy were observed. Mortality rate was 35 per cent but has been reduced to 17 per cent since 1969. The location of bleeding, prompt diagnosis and early treatment are the major factors affecting prognosis. Severe prothrombin complex deficiency due to vitamin K deficiency ac counted for the pathogenesis of bleeding. Possible causes of vitamin K deficiency were discussed but definite conclusions could not be drawn.

Stroke and seizures as the presenting signs of pediatric HIV infection

The authors report two pediatric patients with definite human immunodeficiency virus infection whose initial presentation was stroke and seizure. The first patient was a 3-year-old female who developed acute hemiparesis as the first manifestation. The other, a 2-month-old infant, had focal seizures secondary to cerebral infarction. Investigations revealed ischemic infarction of the thalamus, hypothalamus, and internal capsule in the first patient and cerebral cortex in the second. Further investigations failed to demonstrate any other causes of these cerebral infarctions. Opportunistic infection of the central nervous system was not documented. The authors emphasize that cerebrovascular accident may be the initial presentation in human immunodeficiency virus infection in children. Human immunodeficiency virus infection must be included in the differential diagnosis, and testing for the disease is mandatory in the investigation of stroke in any child who is at risk of having this infection.

Optic neuritis in children: Recurrence and subsequent development of multiple sclerosis

Recurrent optic neuritis and the subsequent development of multiple sclerosis in children, particularly in Asian countries, are not well known. We report on recurrent optic neuritis and subsequent multiple sclerosis in 22 Thai children who were younger than 15 years of age at the onset of optic neuritis, had no previous neurologic illness, and were monitored for 6-20 years. Improvement of vision was observed in 8, 10, and 2 patients after the first, second, and third week of onset, respectively. Two patients had recurrent optic neuritis and the other 2 patients subsequently developed clinical definite multiple sclerosis characterized by hemiparesis at 6 months and myelopathy at 2 years later in 1 patient and myelopathy and brainstem dysfunction in the other at 4 and 6 years later. The frequency of subsequent development of multiple sclerosis after optic neuritis may be similar to that reported from the United States and European countries.

Salmonella meningitis in Thai infants: clinical case reports

Between June 1988 and September 1996 12 of 65 infants (18%) admitted to the Department of Pediatrics, Ramathibodi Hospital, Bangkok, Thailand with purulent meningitis were infected with Salmonella spp. Their ages ranged from 1.5 to 6 months. Six of the infants had diarrhoea, 9 had seizures, and 11 had subdural effusion or empyema. Six infants required surgical treatment; 2 had brain abscesses. Salmonella was recovered from the cerebrospinal fluid of 11 infants and from the subdural fluid of 10. Eight infants were successfully treated with cefotaxime alone or in combination with co-trimoxazole, one with co-trimoxazole, and one with the combination of co-trimoxazole and ampicillin. The duration of treatment was 6 weeks, except for one patient who had a large brain abscess and was treated for 8 weeks. The last 2 patients, despite the fact that the organisms were susceptible to cefotaxime, failed to respond clinically to appropriate doses of it. Both were cured after ciprofloxacin was added to the therapy. Ciprofloxacin is probably the drug of choice to be used in addition to the previously used antibiotics for severe cases of Salmonella meningitis in infants.

Cavernous sinus thrombophlebitis in children

Eight Thai patients less than 15 years of age who were diagnosed with cavernous sinus thrombophlebitis at Ramathibodi Hospital, Bangkok, Thailand over the past 30 years were reviewed retrospectively. The predisposing infections and causative microorganisms were similar to previous reports in children and adults. Despite severe neurologic dysfunction during admission, including blindness, there was neither death nor severe permanent deficit found in the majority of the patients. Only one patient experienced mild hemiparesis caused by cerebral infarction, which was secondary to this condition. Early recognition of this condition, the appropriate selection of empirical antibiotic therapy, and the awareness of associated complication were the key factors leading to excellent outcome.

Internal carotid artery occlusion associated with Mycoplasma pneumoniae infection

A 12-year-old girl with serologically-proved Mycoplasma pneumoniae infection developed right-sided hemiparalysis 10 days after the onset of the disease. Cerebral infarction was documented by cranial computed tomography; cerebral angiography revealed left carotid artery occlusion. Cerebrospinal fluid examination was normal. Cerebral infarction is a rare central nervous system complication of M. pneumoniae infection; however, occlusion of the internal carotid artery near the bifurcation has never been demonstrated; therefore, this patient with central nervous system complication of M. pneumoniae infection is unique.

Association between Chronic Arsenic Exposure and Children's Intelligence in Thailand

Publisher Summary The studies in the past reported high arsenic (As) level in the hair of children at Ronpiboon subdistrict. It is possible that the accumulation of As in their bodies may adversely affect intelligence. The present study aimed to test the association between chronic As exposure, indicated by the As levels in hair, and childrens intelligence among children living in Ronpiboon district since birth. It is a pioneer study conducted in humans, to try to determine the exposure factor related to the developmental defect of children with high As concentrations in their hair. The As levels were measured in hair using atomic absorption spectrophotometry method as the indicator of chronic As exposure and IQ with Wechsler Intelligence Scale Test for Children (WISC). Potential confounders were collected at the same time period of this cross-sectional study between 16 January and 5 March, 1995. The studies established an association between As hair levels and childrens intelligence. The WISC is commonly used in Thai childrens IQ assessment. It has been employed to determine IQ of Thai children for more than 40 years, but there is no study of Thai standard IQ by the WISC at present.

Hydrocephalus in tuberculous meningitis in children: treatment with acetazolamide and repeated lumbar puncture.

Increased intracranial pressure was found in 36 of 49 children with tuberculous meningitis. Four patients who presented with acute onset died early. Eight patients with obstructive hydrocephalus were treated surgically. In the 24 patients who had communicating hydrocephalus and were treated with acetazolamide and repeated lumbar punctures, treatment was successful in all but two, in whom shunt surgery was needed.

Tuberculous meningitis in children: Treatment with isoniazid and rifampicin for twelve months

Patients with tuberculous meningitis were treated with isoniazid and rifampicin for 12 months. To evaluate the result of treatment, we studied the outcome of patients treated from January 1979 to December 1985. Of the 51 patients, 27 were female, and 5, 25, and 21 patients were in the first, second, and third stages of the disease, respectively. Increased intracranial pressure of greater than 200 mm H2O was observed in 42 patients. Three patients required ventriculostomy, and one of them needed ventriculoperitoneal shunting. Three patients died within the first week of admission, and four patients were lost to follow-up. Forty-four patients were followed for 1 1/2 to 7 years; 31 of them recovered completely. Thirteen patients recovered with neurologic sequelae, which included mental retardation, motor weakness, seizures, and hydrocephalus. No serious side effect of the drugs were observed except for transient elevation of liver enzyme activities in four patients. The combination of isoniazid and rifampicin for 1 year, with appropriate management of increased intracranial pressure, seemed to be safe and effective enough to be used as a routine treatment of tuberculous meningitis in areas where resistance to these drugs is uncommon.