Bilateral spinal anterior horn lesions in acute motor axonal neuropathy.

BACKGROUND: Guillain-Barré syndrome is an acute immune-mediated peripheral polyneuropathy. Neuroimaging findings from patients with this syndrome have revealed gadolinium enhancement in the cauda equina and in the anterior and posterior nerve roots, but intra-spinal lesions have never been described. AIM: Herein, we report, for the first time, bilateral spinal anterior horn lesions in a patient with an acute motor axonal neuropathy form of Guillain-Barré syndrome. CASE: The patient was a previously healthy 13-year-old Japanese girl, who exhibited acute-onset flaccid tetraplegia and loss of tendon reflexes. RESULTS: Nerve conduction studies revealed motor axonal damage, leading to the diagnosis of acute motor axonal neuropathy. Notably, spinal magnetic resonance imaging revealed bilateral anterior horn lesions on T2-weighted imaging at the Th11-12 levels, as well as gadolinium enhancement of the cauda equina and anterior and posterior nerve roots. The anterior horn lesions were most prominent on day 18, and their signal intensity declined thereafter. Although intravenous treatment with immunoglobulins was immediately administered, the motor function was not completely regained. CONCLUSION: We propose that anterior spinal lesions might be responsible for the prolonged neurological disability of patients with Guillain-Barré syndrome, possibly produced by retrograde progression from the affected anterior nerve roots to the intramedullary roots, and the anterior horn motor neurons.

Atypical moyamoya syndrome with brain calcification and stenosis of abdominal aorta and renal arteries.

Moyamoya syndrome is a progressive cerebrovascular disease that is characterized by stenosis of the terminal portion of the internal carotid artery and its main branches, in combination with an accompanying disease. We herein describe an 8-year-old boy exhibiting transient loss of consciousness, who had recurrent seizures in infancy with progressive brain calcification. On admission, he was alert but magnetic resonance angiography showed bilateral stenosis of the whole internal carotid artery and proliferation of vascular collaterals, and brain CT revealed calcification on bilateral putamen. Given that this fulfilled diagnostic criteria, we finally diagnosed him as having moyamoya syndrome, though the etiology was unclear. Interestingly, a whole vessel survey revealed vascular stenosis of abdominal aorta and renal arteries, in which the former has not been reported in moyamoya syndrome. We considered that brain calcification was gradually formed by decreased cerebral vascular flow from infancy, and stenosis of abdominal aorta was possibly extended from renal arteries. This is, moyamoya syndrome with brain calcification and stenosis of abdominal aorta, suggesting that morphological screening of whole vessels containing cerebral and abdominal arteries should be considered in cases of slowly progressive brain calcification.

Pediatric falls: effect of prevention measures and characteristics of pediatric wards.

AIM: This study aimed to identify the effect of fall prevention measures and characteristics of wards on the rate of pediatric falls. METHODS: Data on study variables were collected using a cross-sectional design and questionnaires of 603 randomized general hospitals in Japan. Among the hospitals that were contacted, 252 (41.8%) returned their questionnaires. The questionnaires included the annual number of falls, whether fall prevention measures were implemented, and characteristics of the wards. Data were analyzed from questionnaires from 162 of the hospitals, which included those that answered the number of falls. RESULTS: The pediatric fall rate was 1.36/1000 patient-days. Facilities were more likely to have a lower fall rate if they had a longer "length of stay" (P < 0.001), "shared information in high-risk patients and monitored them carefully" (P < 0.001), had higher totals for the "number of study sessions for novice nurses" (P = 0.01),and "used a pamphlet to educate patients and caregivers regarding appropriate use of side rails" (P < 0.001). Facilities that had a "playroom" (P < 0.001), higher "novice nurse-to-nurse ratio" (P < 0.001), and those at which "caregivers were necessary for hospitalization" (P = 0.04) were more likely to have a higher fall rate. CONCLUSION: The results of the present study suggest that education of parents and novice nurses on fall prevention is the most effective method of reducing pediatric falls. It is important to implement intensive fall prevention for high-risk patients and develop valid pediatric fall risk assessment tools.

Acute scrotum in Kawasaki disease: two case reports and a literature review.

Acute scrotum is a rare complication of acute Kawasaki disease (KD), less well recognized than other disease manifestations. We describe the cases of two patients, aged 59 months and 19 months, with hydrocele testis in the acute phase of KD. Scrotal ultrasound and trans-illumination were used in the diagnosis of hydrocele testis. One patient underwent eventual surgical intervention. We reviewed the literature for a better understanding of the pathogenesis of scrotal symptoms in acute KD and investigated the clinical importance of hydrocele testis. Careful further clinical observation may elucidate the true incidence of this extracardiac symptoms, thereby clarifying the diagnostic value of this possible complication in acute KD.