[Presumed perinatal ischemic stroke: risk factors and clinical and radiological findings]. / Ictus isquemico presumiblemente perinatal: factores de riesgo, hallazgos clinicos y radiologicos.

INTRODUCTION: Presumed perinatal ischemic stroke is a frequent cause of neurological sequelae. We aimed to describe the different clinical findings and risk factors and to analyse the differences according the vascular origin. PATIENTS AND METHODS: Retrospective, descriptive study of patients diagnosed with presumed perinatal ischemic stroke attended at a tertiary pediatric hospital from 1990 to 2015. RESULTS: 44 patients were included. A total of 24 patients (55%) had arterial ischemic stroke and 20 (45%) had periventricular venous infarction. Delay in diagnosis was significantly higher in patients with periventricular venous infarction compared to those with arterial ischemic stroke (14 and 8 months respectively; p = 0.025). Most patients presented with asymmetrical motor development (90%), only < 5% with seizures or non motor delays. Subsequent epilepsy at follow-up was significantly more prevalent in arterial ischemic stroke group (p = 0.020). We determined risk factors theoretically involved in the pathogenesis of presumed perinatal ischemic stroke: prenatal, obstetrical, perinatal, prothrombotic and cardiac. No significant differences between risk factors and vascular origin were found. Prothrombotic abnormalities were common (48.3%). CONCLUSIONS: Investigation in risk factors implicated in presumed perinatal ischemic stroke is required to develop prevention strategies. Delay in diagnosis is higher in periventricular venous infarction group.

TITLE: Ictus isquemico presumiblemente perinatal: factores de riesgo, hallazgos clinicos y radiologicos.Introduccion. El ictus isquemico presumiblemente perinatal es una causa frecuente de secuelas neurologicas importantes. Los objetivos del estudio son describir las caracteristicas clinicas y los factores de riesgo implicados, y analizar las diferencias segun su origen vascular. Pacientes y metodos. Estudio descriptivo retrospectivo que incluye pacientes con diagnostico de ictus isquemico presumiblemente perinatal atendidos en un hospital terciario entre 1990-2015. Resultados. Se incluyeron 44 pacientes: 24 (55%) fueron de origen arterial, frente a 20 (45%) de origen venoso. El diagnostico fue significativamente mas tardio en los de origen venoso que en los de origen arterial (14 y 8 meses respectivamente; p = 0,025). La mayoria comenzo con un deficit motor (90%), y las crisis epilepticas y el retraso psicomotor global fueron menos frecuentes en ambos grupos (< 5%). La prevalencia de epilepsia posterior fue significativamente mas frecuente entre los de origen arterial (p = 0,020). Se analizaron los factores de riesgo teoricamente implicados en su patogenia: prenatales, obstetricos, perinatales, protromboticos y cardiacos, sin hallarse diferencias significativas en la presencia de estos entre los infartos arteriales y los venosos. Encontramos la presencia de al menos una alteracion en el estudio de hipercoagulabilidad en el 48,3% de los pacientes. Conclusion. Es preciso investigar el papel que desempeñan los factores de riesgo implicados en el ictus isquemico presumiblemente perinatal para establecer medidas preventivas. Su diagnostico es mas tardio si el origen es venoso.

Piomiositis por Moraxella osloensis / Pyomyositis due to Moraxella osloensis

No disponible

Tratemos a la persona y al dolor / Let’s treat the person and de pain

No disponible

Presencia de los familiares durante la realización de procedimientos invasivos / Presence of family members while performing invasive procedures. A prospective study

Introducción: En nuestro medio tradicionalmente no se ha permitido a los familiares de los pacientes permanecer junto al niño cuando se realizaban procedimientos invasivos. Objetivo: Evaluar el grado de satisfacción de los familiares, el personal sanitario y del propio paciente con la presencia de los familiares durante la realización de los procedimientos dolorosos en un servicio de urgencias pediátricas. Material y métodos: Se realizó un estudio observacional prospectivo. Se diseñó un protocolo de actuación y se instruyó al personal sanitario. Se diseñó una encuesta con datos demográficos, datos del procedimiento y grado de satisfacción tanto del paciente y su familiar como del profesional sanitario. Resultados: Se obtuvieron datos de 75 procedimientos. En 5 de ellos los familiares rechazaron la opción de estar presentes. Los más frecuentes fueron punciones lumbares (44%), sutura/cura de heridas (22,7%) y venopunciones (17,3%). El 100% de los niños quisieron que sus familiares estuvieran presentes. El 90% de los familiares y el 57% de los profesionales opinaron que la presencia de los familiares había facilitado el procedimiento. El 90% de los familiares y el 76% de los profesionales opinaron que había sido beneficioso para el niño. El 95% de los familiares y el 71% de los profesionales opinaron que se debería dar la opción a los familiares de estar presentes. El 73% de los profesionales quedaron satisfechos. En una escala del 1 al 10 la satisfacción global de los familiares fue de un 9,5. Conclusiones: En nuestra experiencia la presencia familiar es una práctica posible que facilita la realización de los procedimientos dolorosos y resulta beneficiosa para el niño. Encontramos una alta satisfacción familiar y al mismo tiempo una amplia aceptación por parte del personal sanitario(AU)

Introduction: Family members of child patients have traditionally not been allowed to be present during invasive procedures. Objectives: To evaluate the level of satisfaction of family members, healthcare professionals, and the patients themselves, when family members are present during invasive procedures carried out in the pediatric emergency department. Materials and methods: A prospective observational study was carried out, which included a questionnaire containing demographic information, the details of the procedure, and the level of satisfaction of the patient, their family members, and the healthcare professionals present. Results: Data was obtained from 75 procedures. In 5 of these, family members chose not to be present during the procedure. The most frequent procedures were lumbar punctures (44%), laceration repairs (22,7%) and venopunctures (17,3%). All (100%) the children who were asked wanted their family members to be present. 90% of family members and 57% of healthcare professionals were of the opinion that the presence of family members facilitated the procedure. Furthermore, 90% of family members and 76% of healthcare professionals thought that family presence was beneficial to the patient. 95% of family members and 71% of healthcare professionals thought that the option to be present during invasive procedures should be given to family members. 73% of healthcare professionals were satisfied with the presence of family members. On a scale of one to ten, overall satisfaction of family members was 9.5.Conclusions: In our experience, family presence during invasive procedures is possible, and we have found this to be beneficial to the child. We also found that both family members and healthcare professionals were accepting and also satisfied with this new practice policy(AU)

Respuesta clínica rápida y espectacular a plasmaféresis en un caso pediátrico de encefalitis anti-NMDA / Fast and spectacular clinical response to plasmapheresis in a paediatric case of anti-NMDA encephalitis

Introducción. La encefalitis autoinmune contra receptores N-metil-D-aspartato (NMDA) se diagnostica cada vez con mayor frecuencia en la edad pediátrica. Debe sospecharse en niños con sintomatología psiquiátrica, encefalopatía, movimientos anormales o crisis epilépticas. Los casos paraneoplásicos son menos frecuentes que en adultos. Caso clínico. Niño de 2,5 años con cuadro encefalopático subagudo que comenzó con crisis epilépticas seguidas de alteraciones del comportamiento, regresión neurológica, discinesias e insomnio. El estudio del líquido cefalorraquídeo fue normal, en la resonancia magnética craneal existía una lesión periventricular focal y captación leptomeníngea difusa y los electroencefalogramas seriados revelaron una actividad delta de gran amplitud intercalada con actividad epileptiforme intercrítica generalizada. Recibió tratamiento empírico con altas dosis de corticoides e inmunoglobulinas intravenosas sin respuesta. Tras demostrarse la positividad de anticuerpos contra el receptor NMDA se inició la plasmaféresis, con la que experimentó una mejoría rápida y espectacular. Tras más de 18 meses de seguimiento, sus secuelas se limitan a leves alteraciones conductuales y del lenguaje. No ha presentado recaídas ni ha precisado ningún tratamiento de mantenimiento. Conclusiones. La encefalitis anti-NMDA es un trastorno tratable y, ocasionalmente, el primer indicio de una neoplasia subyacente, por lo que su reconocimiento y tratamiento precoz es fundamental. El tratamiento de las formas no paraneoplásicas se basa en la inmunoterapia: glucocorticoides, inmunoglobulinas intravenosas, plasmaféresis e inmunosupresores. La plasmaféresis puede inducir una mejoría rápida y espectacular (AU)

Introduction. Autoimmune encephalitis against N-methyl-D-aspartate (NMDA) receptors is being diagnosed more and more frequently in the paediatric age. It should be suspected in children with psychiatric symptoms, encephalopathy, abnormal movements or epileptic seizures. Paraneoplastic cases are less frequent than in adults. Case report. We report the case of a boy, 2.5 years of age, with subacute encephalopathic signs and symptoms and epileptic seizures followed by behaviour disorders, neurological regression, dyskinesias and insomnia. Results of a cerebrospinal fluid study were normal, the magnetic resonance scan of the head revealed a focal periventricular lesion and diffuse leptomeningeal uptake; moreover, the serial electroencephalograms showed high-amplitude delta activity interspersed with generalised intercritical epileptiform activity. The patient was given empirical treatment with high doses of corticoids and intravenous immunoglobulins with no response. After showing up positive for antibodies against the NMDA receptor, plasmapheresis was begun, which led to his swift and spectacular recovery. After more than 18 months’ follow-up, his sequelae are limited to mild behavioural and language alterations. He has had no relapses and has not needed any kind of maintenance treatment. Conclusions. Anti-NMDA encephalitis is a treatable disorder and, sometimes, the first evidence of an underlying neoplasia, which makes its early recognition and treatment essential. Treatment of the non-paraneoplastic forms are based on immunotherapy: glucocorticoids, intravenous immunoglobulins, plasmapheresis and immunosuppressants. Plasmapheresis can bring about a fast, spectacular improvement (AU)

[Fast and spectacular clinical response to plasmapheresis in a paediatric case of anti-NMDA encephalitis]. / Respuesta clinica rapida y espectacular a plasmaferesis en un caso pediatrico de encefalitis anti-NMDA.

INTRODUCTION: Autoimmune encephalitis against N-methyl-D-aspartate (NMDA) receptors is being diagnosed more and more frequently in the paediatric age. It should be suspected in children with psychiatric symptoms, encephalopathy, abnormal movements or epileptic seizures. Paraneoplastic cases are less frequent than in adults. CASE REPORT: We report the case of a boy, 2.5 years of age, with subacute encephalopathic signs and symptoms and epileptic seizures followed by behaviour disorders, neurological regression, dyskinesias and insomnia. Results of a cerebrospinal fluid study were normal, the magnetic resonance scan of the head revealed a focal periventricular lesion and diffuse leptomeningeal uptake; moreover, the serial electroencephalograms showed high-amplitude delta activity interspersed with generalised intercritical epileptiform activity. The patient was given empirical treatment with high doses of corticoids and intravenous immunoglobulins with no response. After showing up positive for antibodies against the NMDA receptor, plasmapheresis was begun, which led to his swift and spectacular recovery. After more than 18 months' follow-up, his sequelae are limited to mild behavioural and language alterations. He has had no relapses and has not needed any kind of maintenance treatment. CONCLUSIONS: Anti-NMDA encephalitis is a treatable disorder and, sometimes, the first evidence of an underlying neoplasia, which makes its early recognition and treatment essential. Treatment of the non-paraneoplastic forms are based on immunotherapy: glucocorticoids, intravenous immunoglobulins, plasmapheresis and immunosuppressants. Plasmapheresis can bring about a fast, spectacular improvement.

[Presence of family members while performing invasive procedures. A prospective study]. / Presencia de los familiares durante la realización de procedimientos invasivos.

INTRODUCTION: Family members of child patients have traditionally not been allowed to be present during invasive procedures. OBJECTIVES: To evaluate the level of satisfaction of family members, healthcare professionals, and the patients themselves, when family members are present during invasive procedures carried out in the pediatric emergency department. MATERIALS AND METHODS: A prospective observational study was carried out, which included a questionnaire containing demographic information, the details of the procedure, and the level of satisfaction of the patient, their family members, and the healthcare professionals present. RESULTS: Data was obtained from 75 procedures. In 5 of these, family members chose not to be present during the procedure. The most frequent procedures were lumbar punctures (44%), laceration repairs (22,7%) and venopunctures (17,3%). All (100%) the children who were asked wanted their family members to be present. 90% of family members and 57% of healthcare professionals were of the opinion that the presence of family members facilitated the procedure. Furthermore, 90% of family members and 76% of healthcare professionals thought that family presence was beneficial to the patient. 95% of family members and 71% of healthcare professionals thought that the option to be present during invasive procedures should be given to family members. 73% of healthcare professionals were satisfied with the presence of family members. On a scale of one to ten, overall satisfaction of family members was 9.5. CONCLUSIONS: In our experience, family presence during invasive procedures is possible, and we have found this to be beneficial to the child. We also found that both family members and healthcare professionals were accepting and also satisfied with this new practice policy.