Estudio descriptivo de la asfixia perinatal y sus secuelas / A descriptive study of perinatal asphyxia and its sequelae

Introducción. La asfixia perinatal es una causa potencialde daño cerebral y puede dar lugar a alteraciones en el desarrolloneurológico posterior del niño. Durante los últimos años,numerosas investigaciones se han centrado en la fisiopatología dela asfixia intraparto; no obstante, la correlación de la asfixia con eldesarrollo posterior de una lesión cerebral irreversible sigue estandomal definida. Pacientes y métodos. Se realiza un estudio descriptivoretrospectivo sobre todos los recién nacidos asfícticos nacidosen el Hospital General de Segovia durante un período de inclusiónde 10 años (1992-2001). Se revisaron las historias clínicasde estos niños y se recogieron datos tanto de la gestación como delparto, del período neonatal y del período de seguimiento en consultasexternas. Resultados. Durante el período de estudio se diagnosticaron703 casos de asfixia perinatal, lo que supone una incidenciaen nuestra población de 7,2 casos por cada 100 recién nacidos.Sólo se siguió a 116 de estos niños en consultas externas deneurología pediátrica de nuestro hospital por un período mínimode dos años al cumplir criterios de riesgo. De estos 116 casos, el45% (53 casos) presentó manifestaciones neurológicas en el períodoneonatal. A lo largo de los dos años de seguimiento se observaronsecuelas en 42 de los niños expuestos (36%); la más frecuentefue el retraso psicomotor. Conclusión. Para una adecuada interpretaciónde la relación entre asfixia perinatal y los trastornos neurológicospresentes posteriormente en los niños que la han sufrido esnecesario realizar un análisis riguroso del conjunto de datos perinatalesy descartar otras posibles etiologías y mecanismos patogénicos

Introduction. Perinatal asphyxia is a potential cause of brain injury that can produce some alterations on theneurologic development of the newborn. On the last years most part of the investigation have been focused on the physiopathologyof the perinatal asphyxia, but correlation between asphyxia and brain damage is not well defined. Patients andmethods. A retrospective study was made of the patients with the diagnosis of perinatal asphyxia born at the General Hospitalof Segovia during a period of ten years (1992-2001). We took data about gestation, birth, neonatal period and follow-up periodfrom their clinical histories. Results. Over this period of ten years 703 cases of perinatal asphyxia have been diagnosed,supposing this an incidence of 7,2 cases of each 100 newborns. 116 of these newborns present risk factors of brain damage andwere followed at least two years. 53 of the 116 newborns (45%) present evidence of hypoxic-ischemic encephalopathy onneonatal period. During the period of two years, 42 of the asphyxiated infants follow up (36%) present neurologic sequelae,being psychomotor retardation the most common. Conclusion. For a correct interpretation of the relationship betweenperinatal asphyxia and neurologic sequelae we have to analyze all of the perinatal data and discard any other possibleaetiology or pathogenic mechanism

[A descriptive study of perinatal asphyxia and its sequelae]. / Estudio descriptivo de la asfixia perinatal y sus secuelas.

INTRODUCTION: Perinatal asphyxia is a potential cause of brain injury that can produce some alterations on the neurologic development of the newborn. On the last years most part of the investigation have been focused on the physiopathology of the perinatal asphyxia, but correlation between asphyxia and brain damage is not well defined. PATIENTS AND METHODS: A retrospective study was made of the patients with the diagnosis of perinatal asphyxia born at the General Hospital of Segovia during a period of ten years (1992-2001). We took data about gestation, birth, neonatal period and follow-up period from their clinical histories. RESULTS: Over this period of ten years 703 cases of perinatal asphyxia have been diagnosed, supposing this an incidence of 7,2 cases of each 100 newborns. 116 of these newborns present risk factors of brain damage and were followed at least two years. 53 of the 116 newborns (45%) present evidence of hypoxic-ischemic encephalopathy on neonatal period. During the period of two years, 42 of the asphyxiated infants follow up (36%) present neurologic sequelae, being psychomotor retardation the most common. CONCLUSION: For a correct interpretation of the relationship between perinatal asphyxia and neurologic sequelae we have to analyze all of the perinatal data and discard any other possible aetiology or pathogenic mechanism.

Eritrodermia y hepatitis / Erythroderma and hepatitis

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[Acute infantile hemiplegia caused by Coxsackie B virus]. / Hemiplejía aguda infantil por virus Coxsackie B.

INTRODUCTION: Acute infantile hemiplegia (AIH) is a syndrome that appears, typically, in infants without any underlying neurological damage. It can be due to a number of causes, in which viral infections play an important role. We report a case of AIH caused by Coxsackie B virus. CASE REPORT: A 20-month-old female who visited because of fever, vomiting and progressive left hemiparesis. Clinical exploration did not reveal any alteration in the level of consciousness and the only striking feature was the left hemiparesis, with weak deep muscle reflexes. Of the complementary examinations carried out, the most important were: LCR with 80 leukocytes/mm3 (predominance of mononuclear cells), EEG with a persistent focus in the right temporal region (which had become normal at four days) and a positive Coxsackie B virus serology. Progression was completely normal. CONCLUSIONS: AIH is produced as a complication of focal encephalitis which gives rise to a vasculitic phenomenon. Among the infectious causes, one important aetiological agent is the herpes simplex virus. Enterovirus, however, are infrequent. Therefore, until the exact aetiology has been established, it appears wise to begin empirical therapy with acyclovir. When the germs involved in this entity are enterovirus, prognosis is good, although there are reports of cases involving neurological sequelae in the literature.

Hemiplejía aguda infantil por virus Coxsackie B / Acute infantile hemiplegia caused by Coxsackie B virus

Introducción. La hemiplejía aguda (HA) infantil es un síndrome que aparece, característicamente, en lactantes sin daño neurológico de base. Su etiología es diversa, y representan un papel importante las infecciones víricas. Presentamos un caso de HA causada por el virus Coxsackie B. Caso clínico. Se trata de una niña de 20 meses que consulta por fiebre, vómitos y hemiparesia izquierda progresiva. En la exploración, no presenta alteración del nivel de conciencia, y únicamente llama la atención la hemiparesia izquierda, con reflejos musculares profundos débiles. De los exámenes complementarios realizados, cabe destacar: LCR con 80 leucocitos/mm3 (predominio mononuclear), EEG con foco persistente en la región temporal derecha (que se normalizó a los cuatro días) y serología positiva para el virus Coxsackie B. La evolución fue a la normalidad absoluta. Conclusiones. La HA infantil se produce como complicación de una encefalitis focal, que da lugar a un fenómeno vasculítico. Dentro de las causas infecciosas, un agente etiológico importante es el virus herpes simple, y son infrecuentes los enterovirus. De ahí que, hasta que no se determine la etiología exacta, parece conveniente instaurar un tratamiento empírico con aciclovir. Cuando los gérmenes implicados en esta entidad son los enterovirus, el pronóstico es bueno, aunque se han descrito en la literatura casos con secuelas neurológicas (AU)

Introduction. Acute infantile hemiplegia (AIH) is a syndrome that appears, typically, in infants without any underlying neurological damage. It can be due to a number of causes, in which viral infections play an important role. We report a case of AIH caused by Coxsackie B virus. Case report. A 20-month-old female who visited because of fever, vomiting and progressive left hemiparesis. Clinical exploration did not reveal any alteration in the level of consciousness and the only striking feature was the left hemiparesis, with weak deep muscle reflexes. Of the complementary examinations carried out, the most important were: LCR with 80 leukocytes/mm3 (predominance of mononuclear cells), EEG with a persistent focus in the right temporal region (which had become normal at four days) and a positive Coxsackie B virus serology. Progression was completely normal. Conclusions. AIH is produced as a complication of focal encephalitis which gives rise to a vasculitic phenomenon. Among the infectious causes, one important aetiological agent is the herpes simplex virus. Enterovirus, however, are infrequent. Therefore, until the exact aetiology has been established, it appears wise to begin empirical therapy with acyclovir. When the germs involved in this entity are enterovirus, prognosis is good, although there are reports of cases involving neurological sequelae in the literature (AU)

[Neuropediatric healthcare demand in a general hospital]. / Demanda asistencial neuropediátrica en un hospital general.

INTRODUCTION: The few existing studies on the demand for neuropediatric care in Spain offer information of enormous value, contributing to our knowledge of this specialty and of the needs of specialists and their training, as well as to the correct planning and use of economic and human resources. AIM: To determine the real demand, predominant disorders and usefulness of complementary examinations with a view to determining the need for neuropediatric care in a general hospital. MATERIALS AND METHODS: Descriptive, retrospective study of patients attending the neuropediatric department for the first time during a 7-year period and for follow-up visits during a 4-year period. The periods were randomly selected. RESULTS: During this period 1130 children, generating 5033 consultations, were assessed. The total number of visits amounted to 25% of all consultations in the Pediatric Department, involving 31% of the children under 14 years of age in the pediatric population of Segovia. The overall rate of reexaminations/new patients was 3.4. The most frequent diagnosis was headache (32%), followed by non-epileptic paroxysms, febrile convulsions and epilepsy. The disorders requiring the greatest number of follow-up consultations were epilepsy (20%), headache (9%) and febrile convulsions (5%). The rate of reexamination/new patients was significantly higher in pediatric cerebral palsy and epilepsy. Electroencephalogram was the most frequently requested complementary examination, followed by neuroradiological studies. CONCLUSIONS: Demand for neuropediatric care mainly involves headaches, epilepsy, convulsions, non-epileptic paroxysmal disorders, and neonatal neurology in the first years of life. Pressure on neuropediatric departments is great due to the number of patients attending consulting rooms because of functional or self-limiting disorders. This pressure could be reduced by appropriate neurological training of general pediatricians or family doctors.

Trombosis de seno sigmoide como complicación de otitis media / Sigmoid sinus thrombosis as a complication of otitis media

Las complicaciones de la otitis media son relativamente infrecuentes, en particular desde el empleo de antimicrobianos eficaces y la introducción de técnicas quirúrgicas específicas. Se presenta un caso de seudotumor cerebral por trombosis del seno sigmoide izquierdo como complicación intracraneal de una otitis media, revisando las diferentes formas clínicas de trombosis del seno sigmoide y sus opciones terapéuticas (AU)

Demanda asistencial neuropediátrica en un hospital general / Demand for neuropediatric healthcare in a general hospital

INTRODUCCIÓN: Los estudios sobre demanda asistencial neuropediátrica, escasos en nuestro país, ofrecen información de enorme valor para el conocimiento de la especialidad, las necesidades de especialistas y su formación, y contribuyen a la correcta planificación y utilización de los recursos económicos y humanos. OBJETIVO: Conocer la demanda real, patología predominante y utilidad de los exámenes complementarios y determinar así las necesidades de actuación neuropediátrica en la consulta de un hospital general MATERIAL Y MÉTODOS: Estudio descriptivo, retrospectivo, de los pacientes vistos en primera consulta y consultas sucesivas de neuropediatría durante un período de 7 y 4 años, respectivamente, seleccionados aleatoriamente RESULTADOS: En este período fueron valorados 1.130 niños que generaron 5.033 consultas. El número de visitas representa el 25 por ciento de todas las consultas del servicio de pediatría, lo que supone el 31ä de niños menores de 14 años de la población infantil de Segovia, con un índice global de revisiones/pacientes nuevos de 3,4. El diagnóstico más frecuente fue cefalea (32 por ciento), seguido de paroxismo no epiléptico, convulsión febril, y epilepsia. Las patologías que requirieron mayor número de consultas sucesivas fueron epilepsia (20 por ciento), cefalea (9 por ciento) y convulsión febril (5 por ciento). El índice revisiones/pacientes nuevos fue significativamente elevado en la parálisis cerebral infantil y la epilepsia. El EEG fue el examen complementario más solicitado, seguido de los estudios neurorradiológicos. CONCLUSIÓN: La demanda neuropediátrica está constituida en su mayoría por cefaleas, epilepsias, convulsiones, trastornos paroxísticos no epilépticos y neurología neonatal y de los primeros años de la vida. Existe una elevada presión asistencial que proviene en gran medida de trastornos funcionales o autolimitados y que podría reducirse con una correcta formación neurológica en atención primaria (AU)

Malformación adenomatoidea quística: dos formas clínicas de presentación / Cystic adenomatoid malformation: two clinical forms of presentation

La malformación adenomatoidea quística (MAQ) es una enfermedad infrecuente. Consiste en una proliferación anormal de elementos mesenquimales pulmonares secundaria a un fallo madurativo de estructuras bronquiolares. Presenta una serie de rasgos anatomopatológicos comunes y otros diferenciadores en los cuales se basa su clasificación. Se asocia, en ocasiones, a otras malformaciones y puede manifestarse clínicamente como: hydrops fetalis, distrés respiratorio neonatal y, en ocasiones, mantenerse silente, incluso durante largo tiempo. Es posible su diagnóstico prenatal aunque la confirmación requerirá el estudio anatomopatológico de la lesión. El tratamiento es quirúrgico. Presentamos dos casos de MAQ con dos formas diferentes de presentación (AU)

[Relapses and complications of acute lymphoblastic leukemia in childhood: a review of cases]. / Recaídas y complicaciones de la leucemia linfoblástica aguda en la infancia: una revisión de nuestros casos.

The relapses and complications happened on the 17 cases of children with acute lymphoblastic leukemia in the Hospital General de Segovia have been reviewed from November 1974 to September 1989. Those which have a higher interest because of their relevance or infrequency have been under discussion. Among the relapses the pulmonary and the testicular are singled out. We differentiate between the complications produced during the treatment and the long-term ones, pointing up varicella as an infectious complication.

[Familial Crohn disease]. / Enfermedad de Crohn familiar.

Authors report two cases of Crohn's disease in a brother and a sister. Female showed first manifestation at 8 years of age. Male started at 12 years. Onset was acute in the girl with ileo-cecal and colonic involvement and extraintestinal manifestations. The boy had an insidious onset with ileal involvement and striking rectal and perianal symptoms. In both cases, clinical course was chronic and relapsing. HLA A and B phenotypes were studied in both patients and their parents. Different factors concerning origin of disease, as well as relationship to other diseases among relatives are discussed.