Assuntos
Varicela/complicações , Eletrocardiografia , Bloqueio Cardíaco/etiologia , Púrpura Trombocitopênica Idiopática/complicações , Varicela/diagnóstico , Pré-Escolar , Diagnóstico Diferencial , Ecocardiografia , Seguimentos , Bloqueio Cardíaco/diagnóstico , Bloqueio Cardíaco/fisiopatologia , Frequência Cardíaca , Humanos , Masculino , Púrpura Trombocitopênica Idiopática/diagnósticoRESUMO
Tuberculous radiculomyelitis (TBRM) is an uncommon complication of TB meningitis. The authors report the case of a 10-year-old Asian girl with trisomy 21, who presented with acute urinary retention and fever. She was initially treated for a urinary tract infection. After an acute neurological deterioration she was found to have evidence of TB meningitis with TBRM. She developed acute hydrocephalus requiring ventriculo-peritoneal shunt. She was treated with quadruple antituberculous therapy and high dose intravenous dexamethasone. She needed tracheostomy with continuous positive airway pressure (CPAP) support. Although she showed gradual neurological improvement in her cognitive functions, she persisted to have quadriparesis with the need for tracheostomy and CPAP support overnight and gastrostomy feeding. Acute urinary retention in children is uncommon, and should serve as a 'red flag' to consideration of further underlying neurological problems. This presentation and subsequent events should serve as a learning point to clinicians.
Assuntos
Antituberculosos/uso terapêutico , Síndrome de Down/complicações , Mielite/diagnóstico , Mielite/microbiologia , Radiculopatia/diagnóstico , Radiculopatia/microbiologia , Tuberculose Meníngea/complicações , Tuberculose Meníngea/diagnóstico , Retenção Urinária/etiologia , Criança , Dexametasona/uso terapêutico , Diagnóstico Diferencial , Quimioterapia Combinada , Feminino , Gastrostomia , Glucocorticoides/uso terapêutico , Humanos , Imageamento por Ressonância Magnética , Mielite/tratamento farmacológico , Radiculopatia/tratamento farmacológico , Traqueostomia , Tuberculose Meníngea/tratamento farmacológicoRESUMO
The authors report the case of a 4-year-old boy who presented to the emergency department with acute post-traumatic winging of right scapula following a fall onto his back. The x-ray of his right shoulder showed no fracture. An MRI Scan of cervical spine and brachial plexus did not reveal any abnormalities. He was managed conservatively with regular physiotherapy. At 2 years follow-up, there was no improvement in the winging of his right scapula. He was asymptomatic at rest but complains of pain in the right scapular and shoulder region during swimming limiting his swimming activity. Currently he was being evaluated by the orthopaedic team for corrective surgery.
Assuntos
Escápula/lesões , Dor de Ombro/etiologia , Acidentes por Quedas , Pré-Escolar , Humanos , MasculinoRESUMO
The authors report the case of a 4-year-old boy who presented to the emergency department with acute post-traumatic winging of right scapula following a fall onto his back. The x-ray of his right shoulder showed no fracture. An MRI Scan of cervical spine and brachial plexus did not reveal any abnormalities. He was managed conservatively with regular physiotherapy. At 2 years follow-up, there was no improvement in the winging of his right scapula. He was asymptomatic at rest but complains of pain in the right scapular and shoulder region during swimming limiting his swimming activity. Currently he was being evaluated by the orthopaedic team for corrective surgery.
Assuntos
Acidentes por Quedas , Paralisia/etiologia , Traumatismos dos Nervos Periféricos/diagnóstico , Escápula , Nervos Torácicos/lesões , Pré-Escolar , Humanos , Masculino , Traumatismos dos Nervos Periféricos/complicaçõesRESUMO
Idiopathic intracranial hypertension is characterized by high cerebrospinal fluid pressure with no underlying structural or systemic cause. Idiopathic intracranial hypertension without papilledema, although well-described in adults, is rarely reported in the pediatric population. The usual presentation is similar to that of chronic daily headache, with some features of migraine. However, treatment modalities are different, and specific therapy can lead to significant improvement in symptoms. We describe six children with chronic daily headache, who were diagnosed with idiopathic intracranial hypertension without papilledema. The response to medical management was variable. One child required a lumboperitoneal shunt for persistent signs, with good surgical outcome.
