RESUMO
Trapped fourth ventricle (TFV) as a complication of post-hemorrhagic hydrocephalus (PHH) is widely reported in the pediatric population with a prior history of ventriculo-peritoneal (VP) shunt placement. Characterized by disproportionate dilatation of the fourth ventricle on serial neuro-imaging, it is rarely encountered in the early course of preterm infants and the differentiating clinical features are subtle and non-specific. Clinical alertness and sonographic correlation hold the key to early diagnosis. We report an early emergence of TFV in an extremely low gestational age newborn (ELGAN) following fulminant Pseudomonas aeruginosa meningitis, approach to management, and the neurological outcome. Fourth ventricle entrapment as a complication of perinatally acquired Pseudomonas aeruginosa meningitis in a surviving ELGAN is extremely rare.
Assuntos
Quarto Ventrículo , Meningites Bacterianas , Pseudomonas aeruginosa , Descompressão Cirúrgica/métodos , Feminino , Quarto Ventrículo/diagnóstico por imagem , Quarto Ventrículo/patologia , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/etiologia , Hidrocefalia/fisiopatologia , Hidrocefalia/terapia , Lactente Extremamente Prematuro , Recém-Nascido , Meningites Bacterianas/complicações , Meningites Bacterianas/microbiologia , Meningites Bacterianas/terapia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Neuroimagem/métodos , Monitorização Neurofisiológica/métodos , Pseudomonas aeruginosa/isolamento & purificação , Pseudomonas aeruginosa/patogenicidade , Ultrassonografia/métodosRESUMO
Food allergy is being increasingly recognised with the highest prevalence being in preschool children. Pathogenesis varies so diagnosis rests on careful history and clinical examination, appropriate use of skin prick and serum-specific IgE testing, food challenge, and supervised elimination diets. A double blind placebo controlled food challenge is the gold standard diagnostic test. Avoidance of the allergenic food is the key towards successful management. IgE mediated food allergy may present as a potentially fatal anaphylactic reaction, and management consists of the appropriate use of adrenaline (epinephrine) and supportive measures. Sensitisation remains a key target for intervention. Disease modifying agents are currently under trial for managing difficult allergies. Management requires a multidisciplinary approach and follow up.