Response to cimetidine in a 1-year-old child with PFAPA syndrome.

Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is characterized by periodic febrile attacks recurring regularly every 2 to 8 weeks. Although tonsillectomy is offered as an effective treatment, the effectiveness of cimetidine treatment is still controversial. In this article, we describe two cases. A 1-year-old girl with PFAPA syndrome received cimetidine treatment and febrile attacks were reduced. Tonsillectomy was successfully performed on a 6-year-old boy with PFAPA syndrome. We suggest that the use of cimetidine may reduce febrile attacks of PFAPA syndrome until an age that is safer for tonsillectomy.

Efficacy of dextromethorphan and cyclosporine a for acute encephalopathy.

Acute encephalopathy with biphasic seizures and late reduced diffusion was recently established clinicoradiologically as an encephalopathy syndrome. The outcome of this encephalopathy is characterized by a low mortality rate and high incidence of neurologic sequelae. Although the exact pathogenesis of this encephalopathy is uncertain, excitotoxic injury with delayed neuronal death is proposed. On the basis of this hypothesis, we tried a combination therapy of N-methyl-D-aspartate receptor antagonist, dextromethorphan, and apoptosis inhibitor, cyclosporine A, in four patients with acute encephalopathy with biphasic seizures and late reduced diffusion. All patients recovered except for hyperactivity in one patient. Furthermore, an additional four patients with near-miss encephalopathy, who showed mild disturbance of consciousness at 24 hours after prolonged febrile seizures associated with exanthem subitum, recovered without secondary seizures by the early administration of dextromethorphan. The combination regimen of dextromethorphan and cyclosporine A could be effective for the treatment and prevention of acute encephalopathy with biphasic seizures and late reduced diffusion.

Traumatic basal ganglia hematoma in a fatal traffic accident victim.

A 41-year-old male driver involved in a fatal traffic accident presented with a basal ganglia hematoma on postmortem computed tomographic imaging. Clinicians could not exclude the possibility of non-traumatic intracerebral hemorrhage as the underlying cause of the traffic accident. However, analysis of the head injuries showed that the hematoma was caused by an impact to the front-parietal region directed toward the tentorium. The absence of hypertensive arteriolar changes and hemosiderin deposits in the brain supported the traumatic origin of the hematoma.