ABSTRACT
BACKGROUND: Pediatric headache is a common cause of pediatric emergency department (ED) visits, and 8.8% of cases require imaging. Alarmingly, 12.5% of imaged cases have a pathologic cause. A pediatric patient with a complicated medical history presented to the pediatric ED with multiple cerebral abscesses. The possible causes and contributors to this rare cause of pediatric headache and a review of pediatric headache emergency management are presented.Case Presentation: A 12-year-old male patient with a complex medical and surgical history, including post-repair pulmonary valve stenosis, visited the pediatric ED for intractable and worsening left frontoparietal headache, refractory to ibuprofen, for 6 days. A physical examination revealed severe photophobia and restlessness secondary to severe head pain. Non-contrast brain computed tomography demonstrated two round, bilateral, parietal hypodense lesions with surrounding vasogenic edema. The lesions were consistent with abscesses on magnetic resonance imaging. Eventually, the patient underwent successful surgical abscess drainage and made a full recovery. The patient was lost to follow-up; therefore, no causative bacterial species was determined. CONCLUSION: Managing pediatric headache in emergency settings requires a robust history and physical examination. Cerebral abscesses are an infrequent but fatal cause of pediatric headache and therefore should be considered among the differential diagnoses.
Subject(s)
Brain Abscess , Male , Humans , Child , Brain Abscess/complications , Brain Abscess/diagnostic imaging , Brain Abscess/surgery , Headache/complications , Headache/diagnosis , Magnetic Resonance Imaging , Physical Examination , DrainageABSTRACT
Pediatric chest trauma can present with a wide array of symptoms and with varying rates of morbidity and mortality. Children have unique thoracic anatomical and physiological characteristics, often necessitating diagnostic and management considerations that differ from management of blunt chest injury in adults. This review discusses diagnostic and treatment modalities for commonly encountered injuries in pediatric blunt thoracic trauma, such as pulmonary contusions, rib fractures, pneumothoraces, and hemothoraces. Rarely encountered but high-mortality injuries, including blunt cardiac injury, commotio cordis, tracheobronchial injury, and aortic injury, are also discussed.
Subject(s)
Thoracic Injuries , Wounds, Nonpenetrating , Adult , Humans , Child , Thoracic Injuries/diagnosis , Thoracic Injuries/therapy , Wounds, Nonpenetrating/diagnosis , Wounds, Nonpenetrating/therapy , Emergency Service, HospitalABSTRACT
Head and neck infections can spread to nearby structures, compromising the airway and progressing to life-threatening events. Pediatric head and neck infections can be difficult to recognize; emergency clinicians must know the signs and symptoms of head and neck infections for early diagnosis and urgent management in order to prevent complications and decrease hospitalization rates. This issue reviews presenting signs and symptoms of pediatric head and neck infections, discusses when diagnostic studies are indicated, and offers evidence-based recommendations for management. Conditions reviewed include mastoiditis, sinusitis, Ludwig angina, peritonsillar abscess, retropharyngeal abscess, Lemierre syndrome, and acute suppurative thyroiditis.
Subject(s)
Head/pathology , Infections/therapy , Neck/pathology , Pediatric Emergency Medicine , Practice Guidelines as Topic , Adolescent , Anti-Bacterial Agents/therapeutic use , Child , Child, Preschool , Emergency Service, Hospital , Female , Humans , Infections/diagnosis , Lemierre Syndrome/diagnosis , Lemierre Syndrome/therapy , Ludwig's Angina/diagnosis , Ludwig's Angina/therapy , Male , Mastoiditis/diagnosis , Mastoiditis/therapy , Peritonsillar Abscess/diagnosis , Peritonsillar Abscess/therapy , Physical Examination/methods , Retropharyngeal Abscess/diagnosis , Retropharyngeal Abscess/therapy , Sinusitis/diagnosis , Sinusitis/therapy , Thyroiditis, Suppurative/diagnosis , Thyroiditis, Suppurative/therapyABSTRACT
The aim of this study was to analyse and determine the composition of paralytic shellfish poisoning (PSP) toxins and lipophilic toxins in the Region of Aysén, Chile, in wild endemic mussels (Mytilus chilensis, Venus antiqua, Aulacomya ater, Choromytilus chorus, Tagelus dombeii and Gari solida) and in two endemic carnivorous molluscs species (Concholepas concholepas and Argobuccinum ranelliforme). PSP-toxin contents were determined by using HPLC with fluorescence detection, while lipophilic toxins were determined by using LC-MS/MS. Mean concentrations for the total of PSP toxins were in the range 55-2505 µg saxitoxin-equivalent/100 g. The two most contaminated samples for PSP toxicity were bivalve Gari solida and carnivorous Argobuccinum ranelliforme with 2505 ± 101 and 1850 ± 137 µg saxitoxin-equivalent/100 g, respectively (p < 0.05). The lipophilic toxins identified were okadaic acid, dinophysistoxin-1 (DTX-1), azaspiracid-1 (AZA-1), pectenotoxin-2 (PTX-2) and yessotoxins (YTX). All analysed molluscs contained lipophilic toxins at levels ranging from 56 ± 4.8 to 156.1 ± 8.2 µg of okadaic acid-equivalent/kg shellfish together with YTX at levels ranging from 1.0 ± 0.1 to 18 ± 0.9 µg of YTX-equivalent/kg shellfish and AZA at levels ranging from 3.6 ± 0.2 to 31 ± 2.1 µg of AZA-equivalent/kg shellfish. Furthermore, different bivalves and gastropods differ in their capacity of retention of lipophilic toxins, as shown by the determination of their respective lipophilic toxins levels. In all the evaluated species, the presence of lipophilic toxins associated with biotransformation in molluscs and carnivorous gastropods was not identified, in contrast to the identification of PSP toxins, where the profiles identified in the different species are directly related to biotransformation processes. Thus, this study provides evidence that the concentration of toxins in the food intake of the evaluated species (Bivalvia and Gastropoda class) determines the degree of bioaccumulation and biotransformation they will thereafter exhibit.
