Posterior reversible encephalopathy syndrome in a child with severe multisystem inflammatory syndrome due to COVID-19. / Síndrome da encefalopatia posterior reversível em uma criança com síndrome inflamatória multissistêmica grave devido à COVID-19.

Posterior reversible encephalopathy syndrome is a rare clinical and radiological syndrome characterized by vasogenic edema of the white matter of the occipital and parietal lobes, which are usually symmetrical, resulting from a secondary manifestation of acute dysfunction of the posterior cerebrovascular system. We describe a case of posterior reversible encephalopathy syndrome secondary to SARS-CoV-2 infection in a 9-year-old boy who developed acute hypoxemic respiratory failure and required assisted mechanical ventilation. The child developed multisystem inflammatory syndrome, and he was monitored in the pediatric intensive care unit and was provided mechanical ventilation and vasoactive agents for hemodynamic support. Additionally, he developed pulmonary and extrapulmonary clinical manifestations along with neuropsychiatric manifestations that required close follow-up and were verified using brain magnetic resonance imaging for timely intervention. Currently, there are few reports of children with posterior reversible encephalopathy syndrome associated with multisystem inflammatory syndrome.

A síndrome da encefalopatia posterior reversível é uma rara síndrome clínica e radiológica caracterizada por edema vasogênico da matéria branca dos lobos occipital e parietal, que geralmente são simétricos, resultante de uma manifestação secundária de disfunção aguda do sistema cerebrovascular posterior. Descrevemos um caso de síndrome de encefalopatia posterior reversível secundária à infecção por SARS-CoV-2 em um menino de 9 anos de idade que desenvolveu insuficiência respiratória hipoxêmica aguda e necessitou de ventilação mecânica assistida. A criança desenvolveu síndrome inflamatória multissistêmica e foi monitorada na unidade de terapia intensiva pediátrica, tendo-lhe sido fornecidos ventilação mecânica e agentes vasoativos para suporte hemodinâmico. Além disso, desenvolveu manifestações clínicas pulmonares e extrapulmonares juntamente de manifestações neuropsiquiátricas que necessitavam de seguimento cuidadoso, tendo sido verificadas por ressonância magnética cerebral para intervenção oportuna. Atualmente, há poucos relatos de crianças com síndrome da encefalopatia posterior reversível associada à síndrome inflamatória multissistêmica.

Síndrome da encefalopatia posterior reversível em uma criança com síndrome inflamatória multissistêmica grave devido à COVID-19 / Posterior reversible encephalopathy syndrome in a child with severe multisystem inflammatory syndrome due to COVID-19

RESUMO A síndrome da encefalopatia posterior reversível é uma rara síndrome clínica e radiológica caracterizada por edema vasogênico da matéria branca dos lobos occipital e parietal, que geralmente são simétricos, resultante de uma manifestação secundária de disfunção aguda do sistema cerebrovascular posterior. Descrevemos um caso de síndrome de encefalopatia posterior reversível secundária à infecção por SARS-CoV-2 em um menino de 9 anos de idade que desenvolveu insuficiência respiratória hipoxêmica aguda e necessitou de ventilação mecânica assistida. A criança desenvolveu síndrome inflamatória multissistêmica e foi monitorada na unidade de terapia intensiva pediátrica, tendo-lhe sido fornecidos ventilação mecânica e agentes vasoativos para suporte hemodinâmico. Além disso, desenvolveu manifestações clínicas pulmonares e extrapulmonares juntamente de manifestações neuropsiquiátricas que necessitavam de seguimento cuidadoso, tendo sido verificadas por ressonância magnética cerebral para intervenção oportuna. Atualmente, há poucos relatos de crianças com síndrome da encefalopatia posterior reversível associada à síndrome inflamatória multissistêmica.

ABSTRACT Posterior reversible encephalopathy syndrome is a rare clinical and radiological syndrome characterized by vasogenic edema of the white matter of the occipital and parietal lobes, which are usually symmetrical, resulting from a secondary manifestation of acute dysfunction of the posterior cerebrovascular system. We describe a case of posterior reversible encephalopathy syndrome secondary to SARS-CoV-2 infection in a 9-year-old boy who developed acute hypoxemic respiratory failure and required assisted mechanical ventilation. The child developed multisystem inflammatory syndrome, and he was monitored in the pediatric intensive care unit and was provided mechanical ventilation and vasoactive agents for hemodynamic support. Additionally, he developed pulmonary and extrapulmonary clinical manifestations along with neuropsychiatric manifestations that required close follow-up and were verified using brain magnetic resonance imaging for timely intervention. Currently, there are few reports of children with posterior reversible encephalopathy syndrome associated with multisystem inflammatory syndrome.

[Child neurodevelopment: normal characteristics and warning signs in children under five years]. / Neurodesarrollo infantil: características normales y signos de alarma en el niño menor de cinco años.

The development of the nervous system is a complex process that results in the maturation of structures, the acquisition of skills and finally the formation of the individual as a unique person. This review contains information about the main characteristics of the processes of brain development, the characteristics of normal neurological development in different areas: gross and fine motor, language, sensory and socialization; and it is also accompanied by a description of the major changes in the development, identifiable in the daily clinical work of pediatricians. Our goal is to enhance knowledge in this key area of assessment of early childhood to detect problems sufficiently in advance for their timely intervention.

Neurodesarrollo infantil: características normales y signos de alarma en el niño menor de cinco años / Child neurodevelopment: normal characteristics and warning signs in children under five years

El desarrollo del sistema nervioso es un proceso complejo que tiene como resultado la maduración de las estructuras, la adquisición de habilidades y, finalmente, la formación del individuo como persona única. La presente revisión recoge información acerca de las principales características de los procesos de desarrollo cerebral, las características del desarrollo neurológico normal en las diferentes áreas: motora gruesa y fina, lenguaje, sensorial y socialización; se acompaña también de una descripción de las principales alteraciones en el desarrollo, identificables en la consulta diaria del pediatra. Nuestro objetivo es reforzar el conocimiento en esta área clave de la evaluación del niño menor de cinco años para detectar problemas con la debida antelación para su intervención oportuna...

The development of the nervous system is a complex process that results in the maturation of structures, the acquisition of skills and finally the formation of the individual as a unique person. This review contains information about the main characteristics of the processes of brain development, the characteristics of normal neurological development in different areas: gross and fine motor, language, sensory and socialization; and it is also accompanied by a description of the major changes in the development, identifiable in the daily clinical work of pediatricians. Our goal is to enhance knowledge in this key area of assessment of early childhood to detect problems sufficiently in advance for their timely intervention...

Meningoencefalitis tuberculosa en niños: Experiencia en el Instituto Nacional de Salud del Niño de Lima, 2009 - 2013 / Meningial Tuberculosis in children: Experience in the Instituto Nacional de Salud del Niño from Lima, 2009-2013

Objetivos: Describir las características epidemiológicas, clínicas, de laboratorio y neuroimagen en los niños diagnosticados de meningoencefalitis tuberculosa (MEC TBC) en el Instituto Nacional de Salud del Niño de Lima - Perú. Material y métodos: Estudio retrospectivo y descriptivo de una serie de casos entre enero del 2009 a setiembre del 2013. Resultados: Se seleccionaron 31 casos con diagnóstico de MEC TBC, con una frecuencia de 7,4 casos por año, edad promedio de 7,3 años, la relación varón/ mujer fue 1,2. Los características más frecuentes fueron la desnutrición, el contacto TBC y la TBC pulmonar. Los síntomas más frecuentes fueron la fiebre, vómitos, y somnolencia. El trastorno de la conciencia y el síndrome meníngeo fueron los síndromes neurológicos más comunes. La mayoría ingresaron en estadio II (83,9 %) y egresaron con secuelas mayores (51,6%). Los hallazgos en el líquido cefalorraquídeo (LCR) fueron pleocitosis promedio de 275,6 células /mm3 y mediana de 184 células/mm3 (rango entre 15-1364 células/mm3), el Bacilo de Koch fue aislado por cultivo en el 19,5% de los casos. Los hallazgos más frecuentes de neuroimagen fueron la hidrocefalia (58%), infarto ygranuloma. Seis pacientes con hidrocefaliarequirieron derivación ventricular. Cinco de los pacientes desarrollaron reacción paradójica. La letalidad fue 12,9%.Conclusiones: La incidencia hospitalaria de MEC TBC fue 7,4 casos por año, la mayoría ingresó en estadio IIy egresó con secuelas mayores, en la neuro imagen la hidrocefalia fue el hallazgo más observado, la letalidad fue 12,9%.

Objectives: To describe clinical, epidemiological, laboratory and neuro imaging characteristics of children with Meningeal Tuberculosis (MEC TBC) at the Instituto Nacional de Salud del Niño, in Lima, Peru. Methods: Retrospective, descriptive case series from January 2009 to September 2013. Results: 31 cases with MEC TBC were included, with a frequency of 7.4 cases per year. The average age was7.3 years and boy/girl rate was 1.2. The more frequent characteristics were the malnutrition, a positive TBC contact and pulmonary TBC. The most common clinical findings were fever, vomits, altered consciousness and meningeal signs. Most cases were in the II clinical state of the disease (83.9%) and the majority evolved with severe complications (51.6%). The cerebrospinal fluid (CSF) findings showed an average 275.6 cells/mm3 cells and median of 184 cells/mm3 (15-1364 cells/mm3). The Koch bacillus was identified in 19.5 % of the CSF culture. The more frequent imaging findings were hydrocephalus (58%), cerebral infarct and granuloma. Six children with hydrocephalus needed a cerebral peritoneal shunt and five children evolved with a paradoxical reaction. The mortality was 12.9%. Conclusions: The hospital incidence was 7.4 cases per year, most of them came in stage II of the disease and left with major sequela, the hydrocephalus was the most frequent imaging finding and the mortality was 12.9%.