Comparison of Full Outline of Unresponsiveness Score and Glasgow Coma Scale for Assessment of Consciousness in Children With Acute Encephalitis Syndrome

Objectives: To correlate the Full outline of unresponsiveness (FOUR) score and Glasgow coma scale (GCS) in the assessment of children with acute encephalitis syndrome (AES). Method: This observational study was conducted in the department of pediatrics of a public sector tertiary care center from January, 2019 to March, 2020. All consecutive patients of AES admitted during the study period (n=150) were recruited. Subjects were analyzed using the FOUR score and GCS on admission, and then 12-hourly till discharge/ death. Treatment-related and demographic variables were collected and analyzed. Correlation between FOUR score and GCS scores was calculated using spearman correlation coefficient. Results: Positive correlation was observed between the GCS score and the FOUR score (n=0.82; P<0.001). Conclusion: FOUR score and GCS were comparable to assess the level of consciousness in patients with AES. The possibility of using FOUR score as an alternative to GCS in children with AES needs to be considered.

Encefalitis aguda necrotizante, diagnóstico retador en una niña con deterioro neurológico súbito

La encefalopatía aguda necrotizante (EAN) es una entidad muy poco frecuente, con compromiso neurológico importante, en la cual los hallazgos radiológicos de lesiones en sistema nervioso central necróticas, simétricas y multifocales son esenciales para diagnosticarla. Se asocia a una respuesta inmune exagerada. Se reporta el caso de una niña de 1 año y 3 meses, previamente sana y con un deterioro neurológico súbito posterior a un cuadro febril de un día y convulsiones, con necesidad de reanimación y ventilación. La neuroimagen demostró las lesiones características de EAN y se manejó con tratamiento inmunomodulador así como antibiótico y antiviral. Se aisló únicamente un adenovirus y rinovirus en muestra respiratoria. La paciente sobrevivió con morbilidad importante como secuelas neurológicas, traqueostomía y gastrostomía. Este es el primer de EAN caso publicado en Costa Rica.

Acute necroziting encephalopathy (ANE) is a rare and serious entity, with significant neurological involvement, in which the radiological findings of symmetric and multifocal necroziting lesions in central nervous system are characteristic. It is an immune-mediated disease with incompletely recognized pathogenesis. We present the case of a 1 year old child, previously healthy, that presented with acute neurological deterioration after a day of fever and seizures. She required reanimation and ventilation. Typical findings of ANE were found in neuroimaging and she was treated with inmunomodulating therapy, antibiotics and antivirals. Only rhinovirus and adenovirus were isolated in respiratory sample. The patient survived with significant neurological sequelae. This is the first case of ANE published in Costa Rica.

Burden of central nervous system infection in cases of fever with seizure and its association with outcome: an experience in a tertiary care center of Uttarakhand, India

Background: CNS infections have been linked to adverse neurological sequelae notably seizures and mortality. Although, various etiologies of AFE have been studied, but the mystery still remains untangled for the substantial risk factors for the diagnosis and outcome.Methods: This prospective study was carried out on 67 children between 2 months to 15 years, from (May 2016 to April 2017) tertiary care centre of Uttarakhand. Patients were analysed for demographic variables, haematological parameters, CSF analysis, neuroimaging and their outcome was assessed at one month of follow up.Results: This study showed, 70% (n=47) of the cases presented in acute febrile encephalopathy. Most cases were diagnosed with pyogenic meningitis (40%, n=27) and More commonly occur during rainy season (39%; n=26) radiologically meningeal enhancement (28%; n=18) as the most common finding. Cases of acute febrile encephalopathy with GCS ?5 had significant association with mortality. (Fischer exact value of 0.005; significant at p<0.05).Conclusions: Clinical signs of meningitis are not always reliable, and a laboratory support is required to reach early diagnosis hence. Pseudomonas and MRCONS were the major pathogens responsible for the bacterial meningitis among the paediatric age groups, hence antibiotic management should be planned intensively while culture reports are awaited. Cluster of cases with meningoencephalitis were found in rainy season hence suggested possible etiologies are JE/ Scrub/ Enterovirus. Mortality as well as morbidity was high in cases with acute encephalitis syndrome cause? JE/unknown etiology in this era for modern medicine hence vector control strategies be encouraged.

Diagnosis and treatment of 12 cases of febrile infection-related epilepsy syndrome / 中国医师杂志

Objective@#To investigate the clinical features, diagnosis and treatment of febrile infection-related epilepsy syndrome (FIRES).@*Methods@#The clinical data of 12 children with FIRES admitted to Xiangya Hospital of Central South University from 2015 to 2018 were retrospectively analyzed. The basic information, clinical manifestations, electroencephalogram, imaging examination, treatment and prognosis were analyzed.@*Results@#Of the 12 patients, 7 were male and 5 were female. The age of onset was (7.0±3.7)years (1.3 year to 13 years). The average hospitalization time (34-86 days, median 52 days). Twelve patients were healthy before the disease, and had fever before convulsion. The interval between fever and seizure was (3.5±1.7)days (1-7 days). The status epilepticus and consciousness deficit were the main clinical manifestations. The electrogram of 8 patients showed status epilepticus when admitted. 12 patients had disturbance of consciousness; the acute episodes were focal seizures (100%, 12/12) and generalized tonic-clonic seizures (41.7%, 5/12). All patients used 3-5 antiepileptic drugs (median 4), all treated with hormones and gamma globulin. 4 patients with ketogenic diet (KD) were treated within 2 weeks of onset, and the average duration from onset to electroencephalogram (EEG) improvement was (19.2±5.0)days. In 8 patients who did not use KD within 2 weeks of onset, the average duration from onset to EEG improvement was (29.9±9.6)days.@*Conclusions@#FIRES is more common in normal children with school age. The main manifestation is refractory status epilepticus in the days after acute fever, focal episodes of seizures, anti-epileptic drug resistance. Early initiation of KD produces a favorable prognosis.

Diagnosis and treatment of 12 cases of febrile infection-related epilepsy syndrome / 中国医师杂志

Objective To investigate the clinical features,diagnosis and treatment of febrile infection-related epilepsy syndrome (FIRES).Methods The clinical data of 12 children with FIRES admitted to Xiangya Hospital of Central South University from 2015 to 2018 were retrospectively analyzed.The basic information,clinical manifestations,electroencephalogram,imaging examination,treatment and prognosis were analyzed.Results Of the 12 patients,7 were male and 5 were female.The age of onset was (7.0 ± 3.7)years (1.3 year to 13 years).The average hospitalization time (34-86 days,median 52 days).Twelve patients were healthy before the disease,and had fever before convulsion.The interval between fever and seizure was (3.5 ± 1.7) days (1-7 days).The status epilepticus and consciousness deficit were the main clinical manifestations.The electrogram of 8 patients showed status epilepticus when admitted.12 patients had disturbance of consciousness;the acute episodes were focal seizures (100％,12/12) and generalized tonic-clonic seizures (41.7％,5/12).All patients used 3-5 antiepileptic drugs (median 4),all treated with hormones and gamma globulin.4 patients with ketogenic diet (KD) were treated within 2 weeks of onset,and the average duration from onset to electroencephalogram (EEG) improvement was (19.2 ± 5.0)days.In 8 patients who did not use KD within 2 weeks of onset,the average duration from onset to EEG improvement was (29.9 ± 9.6) days.Conclusions FIRES is more common in normal children with school age.The main manifestation is refractory status epilepticus in the days after acute fever,focal episodes of seizures,anti-epileptic drug resistance.Early initiation of KD produces a favorable prognosis.

Acute Childhood Encephalitis and Encephalopathy following Infectious Symptoms: a Single Center Study / 대한소아신경학회지

PURPOSE: Acute encephalitis and encephalopathy are preceded by respiratory or enteric infection, whose pathogens can be detected more easily with advanced tools. However, studies for pathogens in Korea remain scarce. We investigated the clinical characteristics and pathogens in childhood encephalitis and encephalopathy. METHODS: We retrospectively reviewed the records of children with acute encephalitis and encephalopathy admitted to our hospital between March 2013 and February 2017. RESULTS: The 51 included patients were aged 5.8±4.4 years (mean±standard deviation), comprising 36 with encephalitis (70.6%) and 15 with encephalopathy (29.4%). Respiratory symptoms (62.7%) were more common than enteric symptoms (45.1%). Brain MRI was abnormal in 54.9%, and leu-kocytosis in the cerebrospinal fluid was noted in 41.2%. The prevalence of diseases was highest in winter (29.4%). In encephalitis, eight patients had infective encephalitis (15.7%), comprising enterovirus (N=4), Epstein-Barr virus (N=3; one with HHV6 coinfection), and tsutsugamushi in-fection (N=1). The 11 patients with ADEM included 1each with adenovirus, influenza A, and mycoplasmal infection. One patient with Bickerstaff-brainstem encephalitis had mycoplasmal pneumonia. In the 15 patients with encephalitis of unknown etiology, rhinovirus (N=3), influenza A (N=2), adenovirus (N=1), and mycoplasmal infection (N=6) were found. In the encephalopa-thy group, three patients had abnormal brain MRI: ANE with influenza A, AESD with exanthem subitum, and norovirus-associated MERS. In the remaining 12 patients, influenza A (N=2), ade-novirus, rhinovirus, enterovirus, norovirus (N=1 for each virus), and mycoplasmal infection (N=4) were found. CONCLUSION: Acute childhood encephalitis and encephalopathy were the most prevalent in winter and were fre-quently associated with respiratory infections.

Retinopathy as a Prognostic Marker in Cerebral Malaria.

Objectives: To study the association between fundal changes (malarial retinopathy) and mortality in children with cerebral malaria. Methods: 50 consecutive children (mean age 8.4 y, 23 males) with cerebral malaria (acute febrile encephalopathy and either peripheral smear or Rapid diagnostic test positive for malaria) were evaluated by a single ophthalmologist for any changes of retinopathy. Children were managed as per standard guidelines for treatment of cerebral malaria. Results: P. vivax infection was seen in one child, P. falciparum infection in 42 children, and a mixed infection in 7. Retinopathy was present in 48% of the children. 13 children died during hospital stay. The mean interval from admission to fundus examination was 11.6 (4.64) h. Presence of ‘any retinopathy’ (P=0.02), and either of papilledema (P=0.02), hemorrhages (P=0.005) or vessel changes (P=0.01), were associated with a significantly higher risk of death. Conclusions: Malarial retinopathy is significantly associated with mortality in children with cerebral malaria. It may be used for both prognostication, and triaging for optimum utilization of intensive care facilities in these children.