ABSTRACT
In the spring of 2017, a full-term infant with microcephaly was delivered in South Florida. During first trimester, the mother presented with fever, nausea, and vomiting. She reported no foreign travel for herself or her partner. The infant's neurologic, ophthalmologic, neuroradiologic, and audiologic findings were highly suggestive of congenital Zika syndrome (CZS), confirmed by IgM antibodies and plaque reduction neutralization test. New observations, including peripheral temporal retinal avascularity and peripapillary retinal nerve fiber layer thinning, are presented from this first known case of non-travel-associated CZS in the United States. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e93-e98.].
Subject(s)
Corneal Dystrophies, Hereditary/diagnosis , Eye Infections, Viral/diagnosis , Microcephaly/diagnosis , Optic Nerve Diseases/diagnosis , Pregnancy Complications, Infectious , Zika Virus Infection/diagnosis , Female , Gestational Age , Humans , Infant, Newborn , Pregnancy , RNA, Viral/genetics , Real-Time Polymerase Chain Reaction , Ultrasonography, Prenatal , United States , Young Adult , Zika Virus/genetics , Zika Virus Infection/congenitalABSTRACT
PURPOSE: We evaluated the validity and interrater reliability of encephalographer interpretation of color density spectral array EEG for seizure identification was evaluated in critically ill children and explored predictors of accurate seizure identification. METHODS: Conventional EEG tracings from 21 consecutive critically ill children were scored for electrographic seizures. Four 2-hour long segments from each subject were converted to 8-channel color density spectral array displays, yielding 84 images. Eight encephalographers received color density spectral array training and circled elements thought to represent seizures. Images were reviewed in random order (Group A) or with information regarding seizure presence in the initial 30 minutes and with subject images in order (Group B). Sensitivity, specificity, and interrater reliability were calculated. Factors associated with color density spectral array seizure identification were assessed. RESULTS: Seizure prevalence was 43% on conventional EEG. Specificity was significantly higher for Group A than Group B (92.3% vs. 78.2%, P < 0.00). Sensitivity was not significantly different between Groups A and B (64.8% vs. 75%, P = 0.22). Interrater reliability was moderate in both groups. Ten percent of images were falsely classified as containing a seizure. Seizure duration ≥2 minutes predicted identification (P < 0.001). CONCLUSIONS: Color density spectral array may be a useful screening tool for seizure identification by encephalographers, but it does not identify all seizures and false positives occur.
