ABSTRACT
El síndrome de encefalopatía posterior reversible, previamente conocido como leucoencefalopatía posterior reversible, es una entidad manifestada clínicamente por cefalea, disminución del nivel de conciencia, convulsiones y alteraciones visuales, y radiológicamente como edema cerebral, predominantemente de la sustancia blanca de regiones parietooccipitales en la resonancia magnética. Son múltiples las situaciones que pueden desencadenar el cuadro. Exponemos 5 casos de pacientes oncológicos, 4 de ellos con leucemia linfoblástica aguda, que desarrollaron el síndrome cuando se encontraban bajo tratamiento quimioterápico. Un diagnóstico precoz y un adecuado tratamiento de la hipertensión y las convulsiones son la base para evitar la aparición de secuelas en estos pacientes
Posterior reversible encephalopathy syndrome, previously known as Reversible posterior leukoencephalopathy syndrome, is a clinical-radiological condition characterized by headache, altered mental functioning, seizures and visual alterations, with the magnetic resonance imaging showing cerebral edema, predominantly in the white matter with posterior distribution. Multiple clinical conditions can act as triggers. We present five oncology patients, four of them with acute lymphoblastic leukemia, receiving chemotherapy when they presented with this pathology. A prompt diagnosis, an appropriate therapy for hypertension, and a rapid control of the seizures are the keys to avoiding sequelae
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Leukoencephalopathies/chemically induced , Antineoplastic Agents/adverse effects , Brain Edema/chemically induced , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Magnetic Resonance Spectroscopy , Intracranial Hypertension/etiologyABSTRACT
Posterior reversible encephalopathy syndrome, previously known as Reversible posterior leukoencephalopathy syndrome, is a clinical-radiological condition characterized by headache, altered mental functioning, seizures and visual alterations, with the magnetic resonance imaging showing cerebral edema, predominantly in the white matter with posterior distribution. Multiple clinical conditions can act as triggers. We present five oncology patients, four of them with acute lymphoblastic leukemia, receiving chemotherapy when they presented with this pathology. A prompt diagnosis, an appropriate therapy for hypertension, and a rapid control of the seizures are the keys to avoiding sequelae.
Subject(s)
Antineoplastic Agents/adverse effects , Posterior Leukoencephalopathy Syndrome/chemically induced , Child , Child, Preschool , Female , Humans , MaleABSTRACT
BACKGROUND AND PURPOSE: The aim of this study is to analyze the proportional distribution of epilepsy and epileptic syndromes in children and to describe the magnetic resonance imaging (MRI) abnormalities found in these patients. METHODS: Data from 457 children aged 1 month to 15 years at the time of diagnosis of epilepsy were recorded. A routine MRI has been requested in all patients with epilepsy at diagnosis according to a standardized pediatric seizure protocol. Abnormalities on MRI were classified as either significant or non-significant (standardized scoring system). International League Against Epilepsy criteria were used for diagnoses. RESULTS: The prevalence of significant MRI abnormalities was 21.9% (in infants 42.3%, in childhood 18.2%, and in adolescents 15.9%). The most common abnormalities included white-matter lesions (27.6%), volume loss (19.6%), gray-matter lesions (19.6%), and ventricular enlargement (12%). CONCLUSIONS: The use of MRI and a reliable standardized scoring system at diagnosis of epilepsy in children identified a high rate of significant abnormalities findings. This may have important implications for practice guidelines in this population.
Subject(s)
Brain/pathology , Epilepsy/epidemiology , Epilepsy/pathology , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Magnetic Resonance Imaging , Male , PrevalenceABSTRACT
Objetivos: Exponer los resultados de la implantación de un cribado ecográfico "semiuniversal" para el diagnóstico precoz de la displasia de desarrollo de la cadera (DDC) que incluye a todas las niñas y a los varones con factor de riesgo. Material y método: De los 16.943 recién nacidos en nuestro hospital en 4 años, se estudiaron por ecografía 8.596 (7.892 niñas y 744 varones). El cribado se realizó a las 5 semanas de vida e incluyó seguimiento de las caderas con inmadurez fisiológica. Resultados: Se detectaron 76 niños con DDC resultando una incidencia del 4,4 por mil. La edad media de detección fue de 1,4 meses y la duración media de los tratamientos 3 meses. Se consiguieron bajos índices de displasias tardías (0,2 por mil) y de cirugía (0,3 por mil). Todos los niños curaron sin secuelas. Conclusión: Consideramos al cribado semiuniversal una opción válida al cribado universal, con resultados similares y menor coste
Objective: The purpose of this article is to describe the findings of our semiuniversal ultrasound screening for the early diagnosis of developmental dysplasia of the hip (DDH) including all newborn females and males with risk factors. Materials and methods: 8596 newborn (7852 females and 744 males) underwent sonography from a total of 16943 newborn in our hospital over a four year period. The screening ultrasound was performed when the infant was five weeks old and included follow-up of the hips with physiological immaturity. Results: 76 infants with hip dysplasia were detected with a resulting incidence of 4.4 per thousand. Mean age at diagnosis was of 1.4months and the mean length of treatment was of 3 months. With this strategy low rates of late dysplasias (0.2 per thousand) and surgical treatment (0.3 per thousand) were achieved All infants recovered without secuelae. Conclusion: We consider the semiuniversal screening to represent a valid alternative to the universal screening, with similar results and reduced costs
Subject(s)
Male , Female , Infant, Newborn , Humans , Hip Dislocation, Congenital , Hip Dislocation, Congenital/therapy , Neonatal Screening/methods , Treatment Outcome , Follow-Up Studies , Risk Factors , SpainABSTRACT
Abdominal ultrasonographic study is a part of the acute abdominal pain diagnosis protocol in our hospital. As an internal quality assessment, we performed a six-month prospective study, including those patients who meet one of these requirements: 1st the reason for attendance being non-traumatic abdominal pain 2nd an abdominal ultrasonography achieved at the hospital. Collected data included: demographic characteristics, presenting sign and symptoms, test results, ultrasonography, final diagnosis and treatment. Children attended to the hospital were evaluated through clinical findings to verify concordance between clinical and ultrasound diagnosis, and patients who did not stay at the hospital had telephone follow-up in 2 weeks. A total of 136 patients underwent ultrasonography (7 children did not cooperate and were discarded): 74 females and 55 males with a mean age of 9.52 years. Admission was required in 63 subjects and 66 were sent home after clinical evaluation. Abdominal ultrasonography was performed by the radiologist on duty (occasionally paediatric radiologist). Ultrasound examination, for acute appendicitis, had a sensitivity of 94.8%, specificity of 98.8%, positive predictive value of 97.3% and negative predictive value of 97.8%. Abdominal ultrasonography has showed usefulness for surgical pathology discrimination in acute abdominal pain. When ultrasonography is inconclusive, clinical follow-up and periodical ultrasonography results in a positive change in management and treatment.
Subject(s)
Abdominal Pain/diagnostic imaging , Appendicitis/diagnostic imaging , Abdominal Pain/diagnosis , Abdominal Pain/etiology , Abdominal Pain/surgery , Abdominal Pain/therapy , Acute Disease , Appendicitis/complications , Appendicitis/diagnosis , Appendicitis/surgery , Child , Diagnosis, Differential , Emergencies , Female , Follow-Up Studies , Humans , Male , Predictive Value of Tests , Prospective Studies , Sensitivity and Specificity , Time Factors , UltrasonographyABSTRACT
La ecografía abdominal forma parte del protocolo de diagnóstico del dolor abdominal urgente en nuestro hospital. Como control de calidad interno, realizamos un estudio prospectivo de 6 meses de duración. Incluimos a los pacientes que acudían a urgencias y que cumpliesen dos premisas: 1° que el motivo de consulta fuese el dolor abdominal no traumático y 2° que se realizase una ecografia abdominal. Estudiamos los datos demográficos, clínicos, exploraciones complementarias, diagnóstico ecográfico, diagnóstico final y tratamiento, entre otros. Seguimos la evolución de los enfermos para verificar la concordancia o no, entre el diagnóstico clínico y el ecográfico, tanto en los niños ingresados (mediante la evolución clínica) como en los que fueron remitidos a su domicilio desde urgencias, mediante encuesta telefónica realizada al mes de la consulta. Realizamos 136 estudios (7 fueron descartados por no contestar la encuesta). Incluimos 74 niñas y 55 niños de 9,52 años de media y desviación de 3,74. En 63 casos se ingresaron y en 66 se remitieron a su domicilio tras la consulta de urgencias. Las 129 ecografías abdominales fueron realizadas por el radiólogo de guardia (ocasionalmente pediátrico). El análisis mostró que la ecografía en nuestra serie tuvo, para la apendicitis aguda, una sensibilidad del 94,8 por ciento, especificidad del 98.8 por ciento, un valor predictivo positivo del 97,3 por ciento y negativo del 97,8 por ciento. En nuestro centro la ecografía abdominal demuestra una gran utilidad en la discriminación de la patología quirúrgica como causa de dolor abdominal. En casos dudosos la reevaluación clínica y ecográfica periódicas, garantizan el correcto diagnóstico y tratamiento del enfermo (AU)
