A história natural do autismo infantil em um hospital público pediátrico terciário:evoluções com atrasos globais do desenvolvimento, com regressão parcial e plena / The natural history of infantile autism in a tertiary pediatric public hospital: developments with global developmental delays with full and partial regression

O autismo é um transtorno comportamental, grave, caracterizado pelo início até 36 meses, com sintomas nas áreas de interação interpessoal, comunicação e comportamento e apresenta três formas de evolução: sempre com atraso no desenvolvimento psíquico, perda de alguma habilidade adquirida em base de atraso no desenvolvimento (regressão parcial) e regressão plena. Objetivo: pesquisar a frequência de cada forma de evolução. Métodos: estudo longitudinal em hospital público pediátricoterciário, durante 20 meses, em Ambulatório de Transtornos do Desenvolvimento, com primeira consulta até 48 meses. O DSM-IV foi utilizado como critério diagnóstico assim como as escalas do CARS e do próprio DSM-IV e foram feitas perguntas sobre regressões e atrasos no desenvolvimento, ou não, na evolução inicial do autismo. Resultado: das 86 crianças com sinais clínicos e escalas positivas para autismo, 74,4% sempre tiveram atrasos no desenvolvimento, 17,4% tinham histórico de atrasos no desenvolvimento com algum grau de regressão e somente 8,1% apresentaram histórico de regressão plena. Conclusão: todas as crianças que apresentam histórico de permanentes atrasos nos marcos do desenvolvimento psíquico devem ter o autismo como hipótese diagnóstica.

Autism is a behavioral severe disorder characterized by a start within 36 months of age, with symptoms in the areas of interpersonal interaction, communication, and behavior. It presents three forms of evolution: always with delay in psychic development, loss of some acquired skill on the basis of a delay in development (partial regression), and full regression. Objective: to research the frequency of each form of evolution. Methods: longitudinal study in a tertiary pediatric public hospital in an outpatient Developmental Disorders Clinic, during 20 months, with the first appointment within 48 months of age. The DSM-IV and the CARS and DSM-IV scales were used as diagnostic criteria; questions were asked about regressions and delays in development or not in the initial development of autism. Results: of the 86 children with clinical signs and positive scales for autism, 74.4% always showed delays in development, 17.4% showed a history of delays in development with some degree of regression, and only 8.1% presented a history of full regression. Conclusion: all children with a history of permanent delay in the milestones of psychic developmentshould have autism as the diagnostic hypothesis.

Cerebral infarct in children aged zero to fifteen years.

Cerebral infarcts in children present peculiar characteristics either due to their diversity of causes or due to the unknown nature of the causes. The etiologies of cerebral infarct were reviewed in children from zero to 15 years old, attended at a tertiary hospital, in Ribeirão Preto (Brazil), from 1990 to 1997, adopting the modified Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria of classification; 1-Atherosclerosis in large arteries; 2-Cardioembolic; 3-Occlusion of small vessels; 4-Other etiologies; 5-Undetermined cause. Thirty-nine children were included, 18 males and 21 females, aged 2 months to 15 years, mean age 5.67. The largest group, N=22 (56.4%), included children with "other etiologies", 7 of them aged under two years. The most common etiology was dehydration and septic shock leading to brain hypoperfusion and watershed infarcts. Nine (23%) children had "Undetermined etiology", 7 (17.9%) cardioembolic subtype and none had atherosclerosis. Laboratory improvement is needed for the large number of patients without a defined cause, and the high proportion of children with dehydration in the group with a determined cause emphasizes the need for preventive health actions among infants and children.

Cerebral infarct in children aged zero to fifteen years

Infartos cerebrais em crianças apresentam peculiaridades, como grande variedade de causas e alta freqüência sem etiologia definida. Foram revistos os diagnósticos etiológicos em crianças de zero a 15 anos, atendidas durante o ictus e com imagens cerebrais sugestivas de infarto, entre 1990 e 1997 em hospital terciário de Ribeirão Preto (SP). Adotou-se o critério de classificação modificado do Trial of ORG 10172 in Acute Stroke Treatment (TOAST): 1 - Arterioesclerose de grandes artérias, 2 - Cardioembólico, 3 - Oclusão de pequenos vasos, 4 - Outras etiologias, 5 - Não determinada. Trinta e nove crianças foram incluídas, 18 do sexo masculino e 21 do feminino, com idade variando entre 2 meses e 15 anos e média de 5,67. O maior grupo, com 22 crianças (56,4 por cento), foi o de ''Outras etiologias'', 7 das quais com idades entre 2 meses e um ano. A etiologia mais freqüente foi desidratação e choque séptico, levando a hipoperfusão cerebral e infarto em zonas limítrofes. Nove (23 por cento) com etiologia não determinada constituiram o segundo grupo, 7 (17,9 por cento) apresentaram causas cardioembólicas e nenhum caso foi registrado com arteriosclerose. Ressalta-se a necessidade de investimento laboratorial, considerando-se a alta freqüência de casos sem diagnóstico. O alto número de crianças com infarto decorrente de desidratação requer atenção para ações preventivas em saúde infantil.

Early-onset acute transverse myelitis following hepatitis B vaccination and respiratory infection: case report.

Acute transverse myelitis is an acute inflammatory process of the spinal cord and it is a rare clinical syndrome in childhood. In this paper, we report a case of 3 years-old boy who developed acute onset tetraparesia following a viral respiratory infecction and hepatitis B vaccination. Magnetic resonance imaging of the spinal cord disclosed signal-intensity abnormalities from C4 to C3. A diagnosis of acute transverse myelitis was made and the patient was treated with IV methylprednisolone and IV immunoglobulin. The child had a fair outcome despite of the very acute course of the disease and the presence of a cervical sensory level which usually harbor a poor prognosis.

Early-onset acute transverse myelitis following hepatitis B vaccination and respiratory infection: case report

Acute transverse myelitis is an acute inflammatory process of the spinal cord and it is a rare clinical syndrome in childhood. In this paper, we report a case of 3 years-old boy who developed acute onset tetraparesia following a viral respiratory infecction and hepatitis B vaccination. Magnetic resonance imaging of the spinal cord disclosed signal-intensity abnormalities from C4 to C3. A diagnosis of acute transverse myelitis was made and the patient was treated with IV methylprednisolone and IV immunoglobulin. The child had a fair outcome despite of the very acute course of the disease and the presence of a cervical sensory level which usually harbor a poor prognosis