Síndrome doloroso regional complejo tipo i. Análisis de una casuística infantil / Complex regional pain syndrome type i. An analysis of 7 cases in children

Introducción: El síndrome doloroso regional complejo (SDRC) se caracteriza por la presencia de dolor acompañado de síntomas sensoriales, autonómicos y motores. Es precedido habitualmente por una lesión o inmovilización. Su curso clínico es desproporcionado con respecto a la lesión inicial tanto en su intensidad como en su duración. Su distribución es regional, predominando en las extremidades. Se clasifica en tipo I y tipo II según ausencia o presencia de lesión nerviosa. Casos clínicos: Se presentan 7 casos clínicos, 6 niñas y un varón con SDRC tipo I, con edades comprendidas entre 7-15 años. Tres tenían antecedente de traumatismo previo. En 5 casos los síntomas se localizaron en miembros inferiores. La demora diagnóstica fue entre 4-90 días. Tres pacientes presentaron elementos de ansiedad y depresión. En todos se realizaron pruebas complementarias de imagen e inmunológicas para descartar diagnósticos diferenciales. Se realizó tratamiento interdisciplinario no farmacológico (fisioterapia y psicoterapia) y farmacológico con analgésicos mayores, gabapentina o pregabalina. Todos presentaron buena evolución, sin recidivas en el seguimiento que fue entre 4 meses y 2,5 años. Conclusiones: El poco reconocimiento de este síndrome en niños, la ansiedad familiar que genera y los costos en paraclínica innecesaria, resaltan la importancia de su difusión entre pediatras y neuropediatras para favorecer su reconocimiento, evitar estudios innecesarios y múltiples consultas a especialistas que retrasan el diagnóstico y el inicio de un tratamiento efectivo

Introduction: Complex regional pain syndrome (CRPS) is characterised by the presence of pain accompanied by sensory, autonomic and motor symptoms, usually preceded by a lesion or immobilisation. The clinical course is disproportionate to the initial injury in intensity and in duration. Its distribution is regional, predominantly in limbs. It is classified as type I and type II according to the absence or presence of nerve injury. Cases: We present the cases of seven children, 6 girls and 1 boy, aged 7 to 15 years. Three had a history of previous trauma. In 5 cases, the symptoms were located in the lower limbs. Time to diagnosis was between 4 and 90 days. Three patients had clinical features of anxiety and depression. Imaging and immunological studies were performed to rule out differential diagnoses in all the children. Interdisciplinary treatment was performed with physiotherapy, psychotherapy, and gabapentin or pregabalin. All patients had a good clinical outcome, with no relapses in the follow-up period (between 4 and 30 months). Conclusions: CRPS is frequently unrecognised in children, leading to family anxiety and unnecessary para-clinical costs. Paediatricians and paediatric neurologists should be aware of this syndrome in order to avoid delay in diagnosis, unnecessary studies, and multiple visits to specialists, with a view to providing effective treatment

Complex regional pain syndrome type i. An analysis of 7 cases in children.

INTRODUCTION: Complex regional pain syndrome (CRPS) is characterised by the presence of pain accompanied by sensory, autonomic and motor symptoms, usually preceded by a lesion or immobilisation. The clinical course is disproportionate to the initial injury in intensity and in duration. Its distribution is regional, predominantly in limbs. It is classified as type I and type II according to the absence or presence of nerve injury. CASES: We present the cases of seven children, 6 girls and 1 boy, aged 7 to 15 years. Three had a history of previous trauma. In 5 cases, the symptoms were located in the lower limbs. Time to diagnosis was between 4 and 90 days. Three patients had clinical features of anxiety and depression. Imaging and immunological studies were performed to rule out differential diagnoses in all the children. Interdisciplinary treatment was performed with physiotherapy, psychotherapy, and gabapentin or pregabalin. All patients had a good clinical outcome, with no relapses in the follow-up period (between 4 and 30 months). CONCLUSIONS: CRPS is frequently unrecognised in children, leading to family anxiety and unnecessary para-clinical costs. Paediatricians and paediatric neurologists should be aware of this syndrome in order to avoid delay in diagnosis, unnecessary studies, and multiple visits to specialists, with a view to providing effective treatment.

Enfermedad por arañazo de gato: características clínicas en niños hospitalizados / Cat scratch disease: Clinical characteristics in hospitalised children

Introducción: En Uruguay hay escasas comunicaciones en relación a las características epidemiológicas y clínicas de la enfermedad por arañazo de gato (EAG) en niños. Objetivo: Describir las características clínicas de los niños hospitalizados en el Hospital Pediátrico, Centro Hospitalario Pereira Rossell con EAG. Pacientes y métodos: Estudio descriptivo, retrospectivo, realizado entre el 01-01-2004 y el 31-12-2008. Se describen manifestaciones clínicas, tratamiento y evolución. Resultados: Fueron hospitalizados 15 niños. Todos presentaron adenopatías regionales, 8 presentaron fiebre prolongada. Presentaron compromiso hepático y/o esplénico 13. Ninguno falleció ni presentó secuelas. Conclusiones: Se recomienda incluir en la valoración de niños con fiebre prolongada y adenopatías la ecografía abdominal y la búsqueda de esta etiología (AU)

Introduction: There are few communications as regards the epidemiology and clinical features of cat scratch disease (CSD) in Uruguayan children. Objective: To describe the clinical features in hospitalised children at Pereira Rossell ChildrenŒs Hospital with CSD. Patients and methods: A descriptive, retrospective study between 01/01/04 and 12/31/08. Clinical features, treatment and evolution were analysed. Results: There were 15 hospitalised children. All had regional lymphadenitis, 8 had prolonged fever; 13 had liver and/or splenic involvement. No patient died or had sequelae. Conclusions: It is important to search for this aetiology in children with prolonged fever and lymphadenitis. Abdominal ultrasound is an important diagnostic step (AU)

[Cat scratch disease: clinical characteristics in hospitalised children]. / Enfermedad por arañazo de gato: características clínicas en niños hospitalizados.

INTRODUCTION: There are few communications as regards the epidemiology and clinical features of cat scratch disease (CSD) in Uruguayan children. OBJECTIVE: To describe the clinical features in hospitalised children at Pereira Rossell Children's Hospital with CSD. PATIENTS AND METHODS: A descriptive, retrospective study between 01/01/04 and 12/31/08. Clinical features, treatment and evolution were analysed. RESULTS: There were 15 hospitalised children. All had regional lymphadenitis, 8 had prolonged fever; 13 had liver and/or splenic involvement. No patient died or had sequelae. CONCLUSIONS: It is important to search for this aetiology in children with prolonged fever and lymphadenitis. Abdominal ultrasound is an important diagnostic step.