[Arterial ischemic stroke in childhood and adolescence]. / Arteriell ischämischer Schlaganfall im Kindes- und Jugendalter: Zeitkritischer Notfall in der Pädiatrie.

Childhood arterial ischemic stroke is one of the most time-critical pediatric emergencies but is often diagnosed with a prognostically relevant time delay. The reasons are low awareness, sometimes unspecific clinical presentation with a wide variety of critical differential diagnoses and less coordinated acute care structures. The revascularization strategies established for adults also show sometimes spectacular success in children. These should therefore also be made available for affected children if possible, although the evidence is nowhere near comparable. In the postacute phase the etiological work-up is complex due to the risk factors which need to be considered, but identification of the individual risk profile is essential as it defines secondary prevention, risk of recurrence and outcome. The long-term care in a multiprofessional, interdisciplinary team must take into account all bio-psycho-social aspects of the child in the current developmental phase.

[Is there an association between the reduced school years in grammar schools and headache and other health complaints in adolescent students?]. / Besteht ein Zusammenhang zwischen der verkürzten Gymnasialzeit und Kopfschmerzen und gesundheitlichen Belastungen bei Schülern im Jugendalter?

BACKGROUND: The reduction of school years in grammar schools from 9 to 8 years (G9 vs. G8) is supposed to exhibit increased impairments of health of the latter group of students. Aim of the present study was to investigate whether G8-students are exposed to more stress and report more headaches and other health complaints than G9-students. PARTICIPANTS: 1 260 formers of grammar schools in Munich (10 (th) vs. 11 (th) form). METHODS: In a survey, the frequency of headache and other health complaints, experience of chronic stress and health-related quality of life were assessed with a questionnaire and compared between the two groups of different grammar-school durations (G8 vs. G9). RESULTS: 83.1% of all formers reported to suffer from headache at least once per month. Further frequently reported health complaints were back pain (47.7%), excessive need for sleep (45.6%) and pain in neck or shoulder (45.0%). 20.4% of the formers reported high exposure to stress. The greatest reductions in quality of life were found with respect to school-related and physical wellbeing. As the only significant differences, formers of G8 reported fewer daily leisure time and that available leisure time was not sufficient for recreation. CONCLUSIONS: The high prevalence of pain, health complaints and stress indicates high demands to all grammar scholars. High demands due to the reduction of school years in grammar school, however, are not reflected in increased health impairments in these formers, but rather in limited leisure time activities.

Arterial thrombosis in homozygous antithrombin deficiency.

UNLABELLED: Antithrombin (AT), a serin protease inhibitor (serpin) produced in the liver, inhibits mainly thrombin and factor Xa. Antithrombin deficiency (AD) is associated with a higher incidence of thrombosis. CASE REPORT: We report a newborn with uncomplicated birth in the 40+5 week of gestation and postnatal appearance of a reticular, livide haematoma on the right upper arm and a tonic clonic epileptic seizure. Clinical examination revealed weak pulses in the A. radialis and ulnaris. MRI scan showed a large thrombus in the A. carotis interna and externa with large cerebral infarction and a thrombus in the A. subclavia. Laboratory work up showed elevated D-dimers and antithrombin levels <20% (lowest 15%), age-related values for protein C, protein S, plasminogen, and no other inherited thrombophilia. THERAPY: We started anticoagulation with unfractionated heparin intravenously (aPTT: 50-60 s) and under suspicion of an AD the substitution of AT (70 U/kg body weight). In course of time we changed anticoagulation to low molecular weight heparin (Anti Xa 0.6-0.8 U/ml) and substitution of 250 E/kg AT every second day. In the molecular work up we found a homozygous missense mutation in exon 2 of SERPINC1 gene (type "Budapest 3"). Molecular analysis showed also heterozygous mutations in both parents and a homozygous mutation in the asymptomatic brother aged three years. At age of six months we changed the anticoagulation to coumadin (INR 2.5-3.5). Anticoagulation with coumadin was also started in the brother. DISCUSSION: Hereditary AD is associated with an increased risk of thrombosis. The homozygous status mainly leads to intrauterine fetal loss or the occurrence of peri- and postnatal thrombosis. Therapy consists in the substitution of AT and a lifelong anticoagulation with vitamin K antagonists also in asymptomatic patients.