RESUMO
Objective: To determine functional outcome of acute disseminated encephalomyelitis in children and factors affecting outcome at The Children's Hospital, Lahore
Study Design: Cross-sectional observational study
Place and Duration of Study: Department of Pediatric Neurology, The Children's Hospital and Institute of Child Health, Lahore from Nov 2014 to Oct 2015
Material and Methods: Fifteen patients with acute disseminated encephalomyelitis fulfilling the inclusion criteria were enrolled. Detailed history, examination, prior febrile illness and modified Rankin scale score for functional disability at presentation and discharge were recorded through study proforma. All patients underwent lumbar puncture and neuroimaging. Data were analysed in SPSS [v.20] and Chi-square test was applied to find p-value
Results: Out of 15 patients, there was male predominance [10 male 66.7 percent] with mean age 7.4 +/- 2.5 years. Encephalopathy 100 percent [n=15] followed by fever, fits 73.3 percent [n=11] and motor deficit 60 percent [n=9] were common presentation. About 46.7 percent [n=7] cases had prior febrile illness. MRI brain had >5 lesions in 86.7 percent [n=13] with sub-cortical area 93.3 percent [n=14] periventricular area 86.7 percent [n=13]. Functional outcome was good in 80 percent [modified Rankin scale of 2 or less at time of discharge]. Consciousness level and disability score at presentation were statistically significant factors affecting the outcome [p-value 0.004 and 0.002 respectively]
Conclusion: Acute disseminated encephalomyelitis in children had variable clinical presentation. It has good outcome with level of consciousness and disability score being significant factors affecting outcome
RESUMO
Objective: To determine the causes of arterial ischemic stroke and neuroimaging findings in children
Study Design: An observational, prospective, cross-sectional study
Place and Dration of Study: Department of Paediatirc Neurology, Children's Hospital and Institute of Child Health, Lahore for a period of six months from Nov 2014 to Apr 2015
Material and Methods: Children from 1 month to 18 years of age with radiologically confirmed arterial ischemic stroke, occurring 1st time in life, were included in the study. Arterial ischemic stroke [AIS] was confirmed on the basis of history, examination and neuroimaging findings of the brain. Further investigations were done according to the cause of arterial ischemic stroke and neuroimaging brain findings
Results: A total of 72 patients of arterial ischemic stroke were identified over a period of 6 months. Among these, male predominance was found in 53 [73 percent] children. Outpatient department patients outnumbered the indoor patients with stroke in 38 [53 percent] children. Children between 1-5 years of age were the most affected ones [65 percent]. Hemiplagia, fits, hemiparesis and aphasia were the most common presenting features affecting 60 [83 percent], 27 [38 percent], 14 [19 percent] and 8 [11 percent] children respectively. The commonest cause of arterial ischemic stroke was iron deficiency anemia, found in 30 percent [n=22] of the children followed by anemia due to other causes in 27 percent [n=20] and congenital heart diseases in 8.3 percent [n=6] of the children. On neuroimaging studies, parietal lobe was the most affected part of the brain in 23 percent of the children [n=16]. Middle cerebral artery was the major artery affecting 57 percent [n=12] of the patients
Conclusion: Iron deficiency anemia, anemia due to other causes and congenital heart diseases were common etiologies in children with arterial ischemic stroke in our study. Parietal lobe and middle cerebral artery were the most affected areas of the brain on neuroimaging