ABSTRACT
Background and Aim: Kawasaki disease (KD) is a paediatric vasculitis with an unknown aetiology. The aim of this study was to assess the clinical course, treatment and cardiovascular outcomes in children with KD. The secondary purpose of this study was to make a com-parison with the Kawasaki-like disease Multisystem Inflammatory Syndrome in Children (MIS-C), which is triggered by SARS-CoV-2. Method(s): In this observational cohort study, clinical information from KD and MIS-C patients was collected. Data were described and a multivariate analysis was performed to identify risk factors for coronary artery aneurysms (CAAs). Clinical characteristics between KD and MIS-C were compared using chi-squared and Mann-Whitney U tests. Result(s): 1003 KD patients were included. The male-to-female ratio was 3:2, a majority of the patients were lt;5 years old (78.3%), treated with a single dose of intravenous immunoglobulin (IVIG) (90.8%) and treated promptly (lt;10 days) (81.7%). A second dose of IVIG was needed in minority of the patients (24.7%). The main complication of KD were CAAs and known risk factors (i.e., male, young age, delayed treatment) for CAAs were confirmed. A total of 35 MIS-C patients were included for the comparison. These patients were older than the KD patients (Plt;0.0005), more often had an incomplete KD presentation (Plt;0.0005). MIS-C patients mainly presented with acute cardiac dysfunction, with complete recovery after treatment. Conclusion(s): KD and MIS-C are severe post-infectious inflamma-tory diseases. Due to the risk of cardiovascular complications, vigi-lance and prompt treatment are advised to reduce risk of cardiovascular complications.
ABSTRACT
BACKGROUND AND OBJECTIVE: Spontaneous cerebrospinal fluid leak of the temporal bone is an emerging clinical entity for which prompt and accurate diagnosis is difficult given the subtle signs and symptoms that patients present with. This study sought to describe the key temporal bone abnormalities in patients with spontaneous cerebrospinal fluid leak. METHODS: A retrospective cohort study was conducted of adult patients with biochemically confirmed spontaneous cerebrospinal fluid leak. Demographics and radiological features identified on computed tomography imaging of the temporal bones and/or magnetic resonance imaging were analysed. RESULTS: Sixty-one patients with spontaneous cerebrospinal fluid leak were identified. Fifty-four patients (88.5 per cent) underwent both temporal bone computed tomography and magnetic resonance imaging. Despite imaging revealing bilateral defects in over 75 per cent of the cohort, only two patients presented with bilateral spontaneous cerebrospinal fluid leaks. Anterior tegmen mastoideum defects were most common, with an average size of 2.5 mm (range, 1-10 mm). CONCLUSION: Temporal bone computed tomography is sensitive for the identification of defects when suspicion exists. In the setting of an opacified middle ear and/or mastoid, close examination of the skull base is crucial given that this fluid is potentially cerebrospinal fluid.