[A child with sepsis-associated encephalopathy]. / Encéphalopathie associée au sepsis (EAS), un cas pédiatrique.

Sepsis-associated encephalopathy (SAE) is a diffuse brain dysfunction due to a systemic response to infection. We report the case of a 4-year-old girl with fever and vomiting for 48h, brought to the university hospital of Grenoble because of vigilance disorders, loss of verbal fluency, and a cerebellar syndrome. She had a biological infectious syndrome. Infectious encephalitis was suggested first, but the cerebral scan and the lumbar punction were normal. Magnetic resonance imaging (MRI) showed a diffuse brain edema with extended involvement of cortical and basal ganglia. The electroencephalogram was globally slow. The infectious syndrome was explained by perforated appendicitis with peritonitis, treated by surgery and antibiotic therapy. Other infectious explorations were negative. No metabolic or autoimmune diseases were found. Hence, our final diagnosis was sepsis-associated encephalopathy. After 1 year of follow-up care, her clinical exam, MRI, and EEG were normal. Sepsis-associated encephalopathy has been increasingly described in the adult population, but until today only three pediatric cases have been published. It is diagnosed when the patient has a severe infectious syndrome associated with neurologic symptoms, mostly vigilance or consciousness disorders, no signs of shock, and only when other potential reasons have been ruled out. The MRI shows non-specific diffuse lesions with vasogenic edema on the subcortical substance or on the basal ganglia and the thalami. The electroencephalogram is slowed down on the whole. The main differential diagnoses are infectious encephalitis, acute disseminated encephalomyelitis, and cerebral vasculitis. Posterior reversible encephalopathy syndrome is an MRI diagnosis that presents characteristics similar to SAE. In the future, it could be discovered that it is the same physiopathology. At the moment, we only treat the symptoms and the causative infection. Most of the time, patients have neurologic sequelae that affect their verbal fluency. It can persist from a few months up to 6yrs. Although quite slow, the neurologic progression is good. The mechanisms are studied and there are hopes for specific treatments. The main explanation seems to be immune with alterations of the blood-brain barrier. Cytokines and activated leukocytes may attack the cerebral substance.

[Organizing pneumonia occurring in a child with celiac disease]. / Pneumopathie organisée au cours d'une maladie cœliaque chez l'enfant.

Organizing pneumonia (OP), or bronchiolitis obliterans organizing pneumonia (BOOP), is rare, particularly in children. It affects the small airways and belongs to the group of interstitial lung diseases. Approximately 20 cases in children have been reported, the lack of knowledge of this disease making the diagnosis less likely. Contrary to the findings in adults, where the cryptogenic form is widely present, OP in pediatrics often occurs after a definite cause (infection, transplant, etc.) or in a specific context (dysimmune disease). We report on a teenager who presented with OP in the context of celiac disease, the first case of this association described in the literature.

[Sinus pericranii: a rare transcranial venous anomaly]. / Le sinus pericranii: une anomalie veineuse transcrânienne.

INTRODUCTION: Sinus pericranii is a rare midline cranial venous anomaly. It should be diagnosed radiologically. We report an asymptomatic case in a six-year-old female patient. CASE REPORT: The patient consulted for a congenital asymptomatic bluish mediofrontal swelling. The complaint was strictly esthetic. A color US and MR angiography allowed diagnosing a sinus pericranii. Simple surveillance was decided because of a limited esthetic prejudice and the absence of any functional disorder. DISCUSSION: Sinus pericranii is a communication between extra- and intracranial venous systems. Its diagnosis is suspected when a subcutaneous mass is located on the scalp close to the midline, the volume of which changes with the head's position. It is confirmed by MRI, which usually shows a drainage in the superior sagittal sinus. Surgical treatment is a complex procedure and rarely indicated. A simple follow-up is often proposed because of the usual absence of complications.

[Emergency pediatric thoracic radiology]. / Imagerie thoracique en urgence chez l'enfant.

Pediatric thoracic emergencies are frequent and may be due to a large spectrum of lesions including traumatic and non traumatic pathologies, such as foreign bodies, mediastinal tumors, pulmonary infections, asthma, pneumothorax and delayed manifestations of congenital chest malformations. Emergencies require rapid diagnosis to make a treatment plan and in most cases, radiology plays an essential role. Plain chest radiographs remain the initial study with inspiratory films. In certain circumstances, the use of expiratory films is absolutely necessary. Ultrasonogragraphy is the primary modality for evaluation of pleural effusions. Computed tomography (CT), with volume acquisition and more rapid scanning, is a technique capable of imaging the lungs and mediastinum with excellent spatial resolution in the pediatric population. CT provides more information than chest radiographs. This explains the increasing indications of CT in the evaluation of pediatric thoracic emergencies, more particularly traumatic emergencies.