Assuntos
Doenças Inflamatórias Intestinais/diagnóstico , Indução de Remissão/métodos , Sulfassalazina/administração & dosagem , Administração Oral , Adolescente , Diagnóstico Diferencial , Quimioterapia Combinada , Eritema Nodoso/diagnóstico , Eritema Nodoso/tratamento farmacológico , Eritema Nodoso/etiologia , Feminino , Fármacos Gastrointestinais/administração & dosagem , Glucocorticoides/administração & dosagem , Humanos , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/terapiaRESUMO
AIM: Mortality from malignant middle cerebral artery infarction (MMCAI) approaches 80% in adult series. Although decompressive craniectomy decreases mortality and leads to an acceptable outcome in selected adult patients, there are few data on MMCAI in children with stroke. This study evaluated the frequency of MMCAI and the use of decompressive craniectomy in children. METHOD: We retrospectively reviewed cases of MMCAI from five pediatric tertiary care centers. RESULTS: Ten children (two females, eight males; median age 9y 10mo, range 22mo-14y) had MMCAI, with a median Glasgow Coma Scale score of 6 (range 3-9). MMCAI represented fewer than 2% of cases of pediatric arterial ischemic stroke. Three patients who did not undergo decompression, all of whom had monitoring of intracranial pressure, developed intractable intracranial hypertension, and fulfilled criteria for brain death. In contrast, seven patients underwent decompressive craniectomy and survived, with rapid improvement in their level of consciousness postoperatively. All seven survivors now walk independently with mild to moderate residual hemiparesis and speak fluently, even though four had left-sided infarcts. INTERPRETATION: Decompressive craniectomy can lead to a moderately good outcome for children with MMCAI and should be considered, even with symptomatic stroke and deep coma. Monitoring of intracranial pressure may delay life-saving treatment.
Assuntos
Craniectomia Descompressiva/métodos , Infarto da Artéria Cerebral Média/cirurgia , Adolescente , Pressão Sanguínea/fisiologia , Morte Encefálica , Criança , Pré-Escolar , Craniectomia Descompressiva/efeitos adversos , Feminino , Humanos , Lactente , Infarto da Artéria Cerebral Média/fisiopatologia , Hipertensão Intracraniana/etiologia , Pressão Intracraniana/fisiologia , Imageamento por Ressonância Magnética , Masculino , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Subaponeurotic or subgaleal fluid collection is a rare but important cause of scalp swelling in young infants. Fluid in the subaponeurotic or subgaleal space presents as soft, ill-defined, fluctuant, highly mobile scalp swelling and is not limited by suture lines, which makes it clinically very distinct from other scalp swellings. However, the aetiology of such swelling still remains uncertain but may be related to traumatic labour that manifests after the first few weeks of life. There is no indication for imaging if the condition is diagnosed clinically with confidence. The late subaponeurotic or subgaleal fluid collection resolves spontaneously without any intervention, hence conservative management is the treatment of choice.
