A Case of Chorea in the Recovery Phase of Pneumococcal Meningitis

Movement disorders (chorea, athetosis, ballism) are a rare complication that develops during the course of bacterial meningitis although associations with tuberculous meningitis are established to some extent. Movement disorders are generally believed to reflect injury to the basal ganglia, thalamus, cerebellum and cerebral cortex. Ischemic infarctions of these areas have been proposed as the cause of dyskinesias in bacterial meningitis. We experienced a case of chorea which developed in the recovery phase of pnemococcal meningitis in a 37-month-old boy. The choreic movement was initially misinterpreted as a seizure, and anticonvulsants were administered. The movement continued during the alert state in spite of anticonvulsant therapy but subsided during sleep. EEG showed severely depressed background activitiy with no epileptiform discharge. When the movement was recognized as a choreic movement, anticonvulsants were withheld and haloperidol was administered orally. The abnormal movement gradually disappeared in 3 months. But like the two other previously reported cases of postmenigitic movement disorders, this patient shows severe impairment in cognitive and motor function in the 10 months of follow up. He can only recognize some close persons and can not control the trunk and extremities well. The movement disorder which develops in the recovery phase and lasts for a long period may be associated with poor neurologic prognosis.

A Diagnostic Survey of Newborns for Chromosomal Analysis: Karyotypes in Congenital Anomalies and Dysmrphism / 대한주산의학회잡지

Clinical characteristics of 336 infants referred for chromosomal study during neonatal period from Jan. 1985 to Dec. 1994 to the cytogenetic laboratory of St. Mary's Hospital, Catholic University Medical College were reviewed. Karyotypes were analysed from peripheral blood lymphocyte cultures and G-banding was carried out. A thorough survey of the clinical reasons for chromosomal analysis, prevalence of chromosomal abnormalities in each disease category, and the patterns of chromosomal aberrations were done. The results were as follows, 1) Down syndrome was the most common indication for chromosome analysis in the newborn period, consisting of 37.8 % of all cases referred. Other indications included skeletal anomaly, multi-organ anomalies, cleft lip/palate, ambiguous genitalia, odd looking face, gastrointestinal anomaly, central nervous system anomaly, and Turner syndrome. 2) Overall in 42.9 percent of cases referred, chromosomal abnormalities was found. 3) 1'he percentage of final diagnosis in suspected Down syndrome was 85.0 #96. Overall, of the non-Down syndrome cases, 16.7 96 was given a definitive diagnosis of chromosomal abnomality. In each disease category, 57.1 % of suspected Turner syndrome and 37.2 % of multi-organ anomalies had been proved having chromosomal abnormalities. The percentages of chromosomal aberrations in isolated odd looking face, ambiguous genitalia, and skeletal anomaly were relatively low, around 5 %. None of the newborns referred because of cleft lip/palate, congenital anomalies of gastrointestinal tract or central nervous system had abnormal karyotype. 4) 95.1 % of all cases diagnosed to have chromosomal abnormality had autosomal aberrations, the remainder 4.9 % had sex chromosomal aberrations. 5) Trisomy 21 was the most common numerical aberrations of autosomes, consisting of 87.5 % and trisomy 18, trisomy 13, and mosaicism was 7.1 %, 3.6 96 and 1.8 % of total. 6) 90.7 % of Down syndrome were due to trisomy 21, the rest being translocation (7.4 %) and mosaicism (1.9 %).