Plasmaféresis en un paciente pediátrico afecto de mielitis transversa y síndrome de Guillain-Barré secundario a infección por Mycoplasma pneumoniae / Plasmapheresis in a paediatric patient with transverse myelitis and Guillain-Barré syndrome secondary to infection by Mycoplasma pneumoniae

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[Diffusion-weighted imaging in pediatric central nervous system infections]. / Secuencias de resonancia magnética por difusión en infecciones pediátricas del sistema nervioso central.

INTRODUCTION: Central nervous system (CNS) infections are associated with high morbidity and mortality. Neuroimaging plays an important role in the early diagnosis and characterisation of neurological complications. AIM: To report the findings in diffusion-weighted images (DWI) and its potential contribution to the early diagnosis and prognosis of neurological sequelae. PATIENTS AND METHODS: Descriptive study of a series of 23 patients, between the ages of 1 month and 16 years, who presented with CNS infection. MRI, with DWI, was performed in all of them. RESULTS: We found 13 viral meningoencephalitis and 10 bacterial meningitis. MRI was performed from day one to seventh after hospitalization. We found CNS affection in conventional MRI and/or DWI in 14 of 23 cases (60%). In three patients the neurological injury was only evident in DWI. We found any type of neurological sequelae in 17 of 21 evaluable patients. The most common neurological sequelae we found was epilepsy (9 of 21). When we related sequelae with conventional MRI and DWI we found a trend in associated more severe sequelae when there are pathological findings in neuroimaging, not statistically significant. CONCLUSIONS: DWI sequence can be useful in the early diagnosis of neurological complications in CNS infections.

Secuencias de resonancia magnética por difusión en infecciones pediátricas del sistema nervioso central / Diffusion-weighted imaging in pediatric central nervous system infections

Introducción. Las infecciones del sistema nervioso central (SNC) en pediatría se asocian a una gran morbimortalidad. La neuroimagen desempeña un papel cada vez más importante en la detección precoz de complicaciones neurológicas. Objetivo. Describir los hallazgos encontrados en las secuencias de difusión (DWI) y su posible utilidad en el diagnóstico precoz y el pronóstico de las secuelas neurológicas. Pacientes y métodos. Es un estudio descriptivo retrospectivo de una serie de 23 pacientes, con edades comprendidas entre 1 mes y 16 años, afectos de infección del SNC, a los que se realizó resonancia magnética (RM). Resultados. La clasificación etiológica fue la siguiente: 13 casos de meningoencefalitis vírica y 10 casos de meningitis bacteriana. La RM se realizó entre el primer y séptimo día de ingreso. Encontramos lesión del SNC en RM convencional o DWI en 14 de 23 casos (60%). En tres pacientes, la lesión neurológica (infarto cortical aislado) sólo fue evidente en la DWI. Encontramos algún tipo de secuela neurológica en 17 de 21 casos. La secuela neurológica identificada con mayor frecuencia fue la epilepsia (9 de 21). Al relacionar las secuelas con los hallazgos en RM y con la DWI, vimos una mayor tendencia a encontrar secuelas más graves cuando existen hallazgos patológicos en la neuroimagen, con una relación que no es estadísticamente significativa. Conclusiones. Las DWI pueden ser útiles en el diagnóstico precoz de complicaciones neurológicas en las infecciones del SNC (AU)

Introduction. Central nervous system (CNS) infections are associated with high morbility and mortality. Neuroimaging plays an important role in the early diagnosis and characterisation of neurological complications. Aim. To report the findings in diffusion-weighted images (DWI) and its potential contribution to the early diagnosis and prognosis of neurological sequelae. Patients and methods. Descriptive study of a series of 23 patients, between the ages of 1 month and 16 years, who presented with CNS infection. MRI, with DWI, was performed in all of them. Results. We found 13 viral meningoencephalitis and 10 bacterial meningitis. MRI was performed from day one to seventh after hospitalization. We found CNS affection in conventional MRI and/or DWI in 14 of 23 cases (60%). In three patients the neurological injury was only evident in DWI. We found any type of neurological sequelae in 17 of 21 evaluable patients. The most common neurological sequelae we found was epilepsy (9 of 21). When we related sequelae with conventional MRI and DWI we found a trend in associated more severe sequelae when there are pathological findings in neuroimaging, not statistically significant. Conclusions. DWI sequence can be useful in the early diagnosis of neurological complications in CNS infections (AU)

Plasma endothelin-1 and clinical manifestations of neonatal sepsis.

AIM: To determine whether plasma endothelin-1 (ET-1) relates to clinical manifestations of sepsis in the newborn, especially with systemic hypotension, acidosis, severe hypoxemia (which may represent pulmonary hypertension) and oliguria. METHODS: Prospective study of 35 consecutive newborns with clinical sepsis: 22 with hemoculture-positive (HC+) sepsis and 13 hemoculture-negative (HC-). Plasma ET-1 concentrations were measured within 2 days of the diagnosis of sepsis. SNAP-II severity score was performed at the time of highest clinical severity. RESULTS: Newborns with HC+ sepsis had higher plasma ET-1 concentrations and SNAP-II scores (especially PO 2 /FiO 2 ratio) than HC- septic children. Plasma ET-1 concentrations increased linearly with each item of the SNAP-II score, but only reached significant differences in lowest mean blood pressure (P=0.030), lowest pH (P=0.048), multiple seizures (P=0.010) and lowest urine output (P=0.013). Leukocyte count, immature/total neutrophil ratio and C-reactive protein value were not different. Each item of the SNAP-II score was independently related only to ET-1 level. Oliguria, acidosis and systemic hypotension were more correlated (R 2 >0.5). CONCLUSIONS: Plasma ET-1 levels in neonatal sepsis are related to the severity of clinical manifestations, especially oliguria, acidosis and systemic hypotension.