Moyamoya disease mimicking encephalitis

Moyamoya disease is a rare vaso-occlusive illness with an unknown etiology characterized by stenosis of the internal carotid arteries with spontaneous development of a collateral vascular network. A 15-month-old girl was referred to the emergency ward of Imam Reza Hospital due to decreased level of consciousness, focal seizures and fever during the previous 24 hours with an impression of encephalitis. Physical examination revealed left side hemiparesis; however brain CT-Scan did not show any significant lesions. Initial therapy with vancomycin, ceftriaxone and acyclovir was administered. CSF analysis did not show any abnormality and the blood as well as CSF cultures results were negative. Brain MRI showed hyperintensity at right frontal and parietal regions, suggesting vascular lesion. Magnetic resonance angiography [MRA] showed bilaterally multiple torsions in vessels at the basal ganglia consistent with moyamoya vessels. In all children exhibiting encephalitis, vascular events such as moyamoya disease should be considered. Brain MRI is a critical tool for this purpose. Common causes of encephalitis such as herpes simplex should also be ruled out

How to encounter the child in coma

Non-traumatic coma is a medical emergency and should be evaluated as soon as possible. Pediatric coma is more serious because of patient's capacity of pathological stressor tolerance is limited especially in neonates. Several etiologies could be listed for loss of consciousness [LOC] and coma in childhood. According to the epidemiological studies, causes of coma are different all around the world. Glasgow Coma Scale has been used for coma scaling. In this review, we focused on some highlight causes of coma in pediatric medicine

Clinical features and long term prognosis of childhood brucellosis in northeast Iran

Brucellosis is a prevalent disorder in children of developing countries. The aim of this study is to describe the epidemiology and long term prognosis of Brucellosis in Khorasan, Iran. This is a descriptive cross sectional study [from November 2003 up to February 2006], the subjects of which are composed of 82 patients [from Imam Reza hospital, Mashhad, and Health Center of Kashmar]. In this study the diagnosis of Brucellosis is based on serology accompanied with clinical signs and symptoms. Our strategy for duration of treatment was to treat all patients for at least 6 weeks. We followed the patients by phone and if necessary by visiting. During 38 months we had 82 children with Brucellosis. The mean age was 8.02 y, and 40% of them were girls [M/F=1.21]. Summer with 45.9% of the cases was the peak season. History of consuming raw dairy products, close contact with farm animals, living in village and Brucellosis in family was found in 91.6%, 76%, 70.24% and 41.1% of the cases respectively. The presenting symptom in 79.7% of the cases was joint pain, 72.9% had history of fever during the course of the disease. Arthritis, splenomegaly and lymphadenopathy were found in 60.97%, 16.9%, 7.5%, of patients respectively. The therapeutic regimen of 48.7% of our patients was Co-trimoxazole and rifampin. We followed 74% of the patients for at least 3 years which showed the relapse rate of 6.5%. There was a case of reinfection, a patient with residual sequel and one death related to Brucellosis in our case series. Brucellosis is still a common disease in our children and at least a risk factor for it can be found in the history of almost all cases of pediatric Brucellosis. With at least six weeks treatment with two antibiotics and with close follow up, we can decrease the relapse rate in pediatric Brucellosis to zero, even without repeating the serology during or after treatment

Congenital tuberculosis presenting as ascites

Congenital tuberculosis is a rare disease of which the most common presentations include respiratory distress, fever, and organomegaly. We report a case of congenital tuberculosis presenting with ascites