Neurologic manifestations of Schoenlein-Henoch purpura: report of three cases and review of the literature.

Three patients developed prominent neurologic symptoms and signs associated with Schoenlein-Henoch purpura. A 7 1/2-year-old boy was seen with status epilepticus after a 2-week history of generalized headaches, irritability, and intermittent colicky abdominal pain. A left hemiparesis and a left homonymous hemianopia with a right gaze preference that were present on initial examinations gradually resolved, but a mild left arm paresis persisted. Cutaneous, renal, and joint involvement followed initial CNS manifestations. The second patient, a 7-year-old girl, had a complex partial seizure with secondary generalization and a postictal hemiparesis seven days after presentation with classic signs of Schoenlein-Henoch purpura. Behavioral changes were noted during the acute phase of the illness. The third patient, a 13-year-old boy, developed signs of a left brachial plexopathy and transient weakness of his right leg during a complicated course of Schoenlein-Henoch purpura. Review of the world literature indicates that headaches and mental status changes are the most frequent neurologic complications of Schoenlein-Henoch purpura, followed by seizures, focal neurologic deficits, mononeuropathies, and polyradiculoneuropathies. The vasculitis of Schoenlein-Henoch purpura can involve the nervous system and may add significantly to the morbidity of the illness.

Caustic ingestions. Symptoms as predictors of esophageal injury.

The ingestion of a caustic substance can lead to severe damage to the esophagus. Currently, esophagoscopy is recommended for all patients with a history of caustic substance ingestion because clinical criteria have not proved to be reliable predictors of esophageal injury. The records of 79 consecutive patients younger than 20 years who were first seen with a history of corrosive ingestion were reviewed. The presence or absence of three serious signs and symptoms--vomiting, drooling, and stridor--as well as the presence and location of oropharyngeal burns were compared with the findings on subsequent esophagoscopy. Fifty percent (7/14) of the patients with two or more of these serious signs and symptoms (vomiting, drooling, and stridor) had serious esophageal injury as compared with no positive endoscopic results in the group with none or only one of these clinical findings. The presence of oropharyngeal burns did not identify patients with serious esophageal injury. These results suggest that the presence of two or more signs or symptoms in patients with a history of caustic substance ingestion may be a reliable predictor of esophageal injury.