ABSTRACT
BACKGROUND: Kawasaki disease (KD) is an acute, self-limited vasculitis of unknown etiology that occurs predominantly in infants and young children. Encephalitis/encephalopathy is an extremely rare complication of KD. CASE: A previously healthy 8-month-old Japanese boy had a prolonged seizure after febrile illness for one day. On the fourth day, he had bilateral nonexudative conjunctivitis, changes in the extremities, rash and induration at the Bacillus Calmette-Guerin inoculation site. He was diagnosed with incomplete KD and treated with immunoglobulin. On the fifth day, he had cluster seizures. Brain magnetic resonance imaging (MRI) showed restricted diffusion in the left subcortical white matter, which was consistent with acute encephalopathy with biphasic seizures and late reduced diffusion (AESD). He was treated with controlled normothermia, pulseddose methylprednisolone, continuous infusion of midazolam, and edaravone. On the tenth day, he had a recurrent fever and was treated with a second course of immunoglobulin. Subsequently, he had defervescence, and the abnormal signal detected in the MRI disappeared. At the age of 11 months, he had normal growth and development for his age by the Denver Developmental Screening Test. CONCLUSION: It is necessary to consider AESD as the differential diagnosis of prolonged seizure in infants with KD. Brain MRI led to early diagnosis and intervention in our patient. The neurological prognosis of our patient was relatively good, but the prognosis of KD with AESD is unknown. To clarify this, further case accumulation is warranted.
Subject(s)
Brain Diseases , Mucocutaneous Lymph Node Syndrome , Status Epilepticus , White Matter , Brain Diseases/diagnostic imaging , Brain Diseases/etiology , Child , Child, Preschool , Diffusion Magnetic Resonance Imaging , Humans , Infant , Male , Mucocutaneous Lymph Node Syndrome/diagnosis , Mucocutaneous Lymph Node Syndrome/diagnostic imaging , Seizures , Status Epilepticus/etiology , White Matter/diagnostic imagingABSTRACT
Hamstring strain injury is a multifactorial and complex problem involving interactions among various factors. Information about risk factors for this injury is inconsistent among studies because the strong effects of confounding factors and injury situations are often ignored. We investigated the relationship between hamstring strain induced by high-speed running and intrinsic risk factors, including hip muscle morphology and function, by excluding the influences of confounding factors. Sixty-one male track and field athletes (age, 19.6 ± 1.1 years; 95% confidence interval, 19.3-19.9) who often performed high-speed running were monitored throughout one season. Before the season, we measured hip and knee strength, muscle thickness of the gluteus maximus and biceps femoris, and hip and knee joint range of motion (ROM). We also obtained information about each athlete's history of hamstring injury by questionnaire. Eighteen athletes sustained hamstring strain injuries induced by high-speed running. Eighteen uninjured athletes who had the same profile of confounding factors as the injured athletes were selected as controls. Previously injured athletes had a significantly higher injury rate than uninjured athletes (p < .05; odds ratio, 2.85). No other measurements had a significant relationship with the occurrence of injury. However, passive hip ROM (flexion and extension) tended to be larger in the injured than control group. A history of hamstring strain was a strong risk factor for hamstring strain injury, and it may affect other factors. Therefore, the risk factors for hamstring strain injury should be investigated by eliminating the impact of a history of hamstring strain.
