Subject(s)
Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/diagnosis , Myasthenia Gravis/complications , Myasthenia Gravis/diagnosis , Adolescent , Child , Female , Humans , Incidence , Lupus Erythematosus, Systemic/drug therapy , Lupus Erythematosus, Systemic/epidemiology , Myasthenia Gravis/drug therapy , Myasthenia Gravis/epidemiologyABSTRACT
A 2-month-old white girl born to nonconsanguineous parents presented to the dermatology department with hair loss that had commenced a few months after birth. Although her hair loss later stabilized, it remained sparse. By the age of 2 years, she was noted to have developed focal keratoderma over pressure points of the soles. Aged 5 years, she was admitted to hospital with a chest infection, and investigations at that point revealed that she had a dilated cardiomyopathy. Subsequent genetic investigations identified compound heterozygous mutations in the 3' end of the desmoplakin (DSP) gene (7567delAAGA and 6577G>A), explaining the cardiocutaneous phenotype.
Subject(s)
Alopecia/genetics , Cardiomyopathy, Dilated/genetics , Desmoplakins/genetics , Frameshift Mutation , Hair Follicle/abnormalities , Amino Acid Substitution , Fatal Outcome , Female , Foot Dermatoses/genetics , Heterozygote , Humans , Infant , Keratoderma, Palmoplantar/geneticsABSTRACT
INTRODUCTION: We report the case of a 2-year-old boy with suspected meningitis who presented with acute onset neck pain and stiffness associated with right-sided weakness and ataxia. MANAGEMENT: Despite intravenous antibiotics and antiviral treatment, his condition deteriorated. Magnetic resonance imaging demonstrated spontaneous cervical epidural haematoma (C4-C7) extending down to thoracic (T7) level with associated compression of the spinal cord. He was treated successfully by neurosurgical decompression and made a complete recovery. DISCUSSION: Spinal epidural haematoma is a neurosurgical emergency characterised by extravasation of blood in the spinal epidural space. The clinical presentation particularly in young children can masquerade other conditions such as meningitis. In this article, we discuss our case and review the literature on spontaneous spinal epidural hematoma with an aim to improve awareness of this condition which if not recognised and treated early can lead to significant lifelong morbidity.
Subject(s)
Diagnosis, Differential , Hematoma, Epidural, Spinal/diagnosis , Meningitis/diagnosis , Child, Preschool , Decompression, Surgical , Hematoma, Epidural, Spinal/complications , Hematoma, Epidural, Spinal/surgery , Humans , Magnetic Resonance Imaging , Male , Spinal Cord Compression/etiology , Spinal Cord Compression/surgeryABSTRACT
PURPOSE: To report the effectiveness and safety of intravenous levetiracetam in the treatment of children with acute repeated seizures, and status epilepticus in a children's hospital. METHODS: This two-year observational study evaluated all in-patients who received intravenous levetiracetam to treat acute repeated seizures (ARS) or convulsive and non-convulsive status epilepticus (SE). Information was collected on seizure type, epilepsy syndrome and underlying cause, the initial loading dose of intravenous levetiracetam, its effectiveness and safety and whether the patient remained on the drug at final follow-up. Analysis was descriptive. RESULTS: Fifty-one patients aged 0.2-18.8 (mean 7.1) years were evaluated, including 45 with acute ARS or SE and six unable to continue their usual orally administered anti-epileptic medication. The median initial dose of levetiracetam was 14.4 (range 5-30)mg/kg in the 45 patients treated for acute seizures and SE. Twenty three of the 39 (59%) patients with ARS became and remained seizure-free. Levetiracetam terminated status in three of four (75%) patients with convulsive, and the two patients with non-convulsive status epilepticus. Aggressive behaviour occurred in three children, one of whom discontinued treatment. Forty-two patients (81%), including 34 of the 45 patients (76%) treated for ARS or SE remained on levetiracetam at the time of final follow-up, between two and 18 months after receiving the drug. CONCLUSION: This observational study has confirmed previous data that intravenous levetiracetam seems to be effective and safe in the treatment of acute repeated seizures and status epilepticus. A randomised clinical trial is justified to determine whether intravenous levetiracetam should replace intravenous phenytoin as the first long-acting anticonvulsant in the management of acute repetitive seizures and status epilepticus.
Subject(s)
Anticonvulsants/administration & dosage , Piracetam/analogs & derivatives , Seizures/drug therapy , Status Epilepticus/drug therapy , Adolescent , Anticonvulsants/adverse effects , Child , Child, Preschool , Female , Hospitals, Pediatric , Humans , Infant , Infusions, Intravenous , Levetiracetam , Male , Piracetam/administration & dosage , Piracetam/adverse effectsABSTRACT
A female patient with isovaleric acidaemia had a successful outcome from pregnancy.
