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Case Report
Infectious Cerebellitis Rare Entity About Two Cases
Issue:
Volume 10, Issue 3, September 2024
Pages:
112-116
Received:
28 May 2024
Accepted:
17 June 2024
Published:
8 July 2024
Abstract: Introduction: Cerebellitis is an inflammatory pathology of cerebellar structures more common in children, frequently of post-infectious origin or following vaccination, seldom during a viral or bacterial infection. Ataxia is most frequently caused by dysfunction of the complex circuitry connecting the cerebellum, basal ganglia and cerebral cortex. Results: We report the case of 2 patients aged 3 and 10 years presenting acute cerebellitis of infectious origin: Ataxic syndrome associated with balance disorders and speech disorders and fever. The evolution was quickly favorable with corticosteroid therapy and proprioceptive physiotherapy. The absence of fatalities in our case report suggests early diagnosis, and steroid treatment can increase the chance of recovery. Discussion: Clinical presentations are deceptive and variable with cerebellar symptoms of acute kinetic and static ataxia with inflammatory signs. The treatment is based on steroids when symptoms are moderate to severe. Antimicrobial therapy should always be considered, because ataxia can be a presenting sign of both viral encephalitis and bacterial meningitis. The prognosis for acute cerebellitis is generally favorable. The courses vary from what is commonly a benign and self-limiting disease to what occasionally is fulminant disease resulting in several cerebellar damage or even sudden death. Conclusion: Recognizing ataxia in children can be difficult, which is why a lumbar punction should be considered if infectious cerebellitis is suspected. Most people fully recover, however there is a risk of lasting disability.
Abstract: Introduction: Cerebellitis is an inflammatory pathology of cerebellar structures more common in children, frequently of post-infectious origin or following vaccination, seldom during a viral or bacterial infection. Ataxia is most frequently caused by dysfunction of the complex circuitry connecting the cerebellum, basal ganglia and cerebral cortex. ...
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Case Report
Acute Necrotizing Encephalopathy in Children: A Case Report in Barranquilla-Colombia
Issue:
Volume 10, Issue 3, September 2024
Pages:
117-122
Received:
7 June 2024
Accepted:
10 July 2024
Published:
23 July 2024
Abstract: Acute necrotizing encephalopathy is a rapidly progressive disease of the central nervous system that is generally described in texts as a pathology of pediatric patients, but even in people of this age range, it is rare to find a case of this disease, which presents with a fulminant tissue necrosis and can be secondary to infections, mainly of viral origin. Due to presenting very non-specific clinical manifestations, this diagnosis often goes unnoticed or is made late. ANE survivors go through three phases during the clinical course that include the prodromal stage, the period of acute encephalopathy, and the recovery stage. It is through specific radiological findings observed on computed tomography affecting the bilateral thalamus and possibly the cerebral white matter, brainstem, or cerebellum that the diagnosis can be confirmed. This report discusses the case of an 8-year-old schoolboy who begins with acute gastroenteritis, which progresses with seizures and neurological deterioration. A skull CT scan is performed with imaging findings suggestive of acute necrotizing encephalopathy. Management is established with adequate clinical response and favorable recovery of neurological symptoms. The clinical characteristics and radiological findings are the key to facilitating an early diagnosis, reducing sequelae and improving the prognosis, which provides a chance of life to people who suffer from this condition.
Abstract: Acute necrotizing encephalopathy is a rapidly progressive disease of the central nervous system that is generally described in texts as a pathology of pediatric patients, but even in people of this age range, it is rare to find a case of this disease, which presents with a fulminant tissue necrosis and can be secondary to infections, mainly of vira...
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Research Article
Epidemiological and Cardiovascular Prognostic Profile of Pediatric Arterial Hypertension at the Hospital National Ignace Deen de Conakry (Guinea)
Bangoura Soriba*,
Camara Mohamed Lamine Tegui,
Kaba Fatoumata,
Traore Aly,
Diallo Amadou Yaya,
Tolno Abou,
Toure M’Mahawa,
Barry Kadiatou Mamadou Bobo,
Diakite Fousseny,
Camara Mamadouba,
Cherif Ibrahima,
Traore Moussa,
Kaba Mohamed Lamine,
Bah Alpha Oumar
Issue:
Volume 10, Issue 3, September 2024
Pages:
123-127
Received:
10 June 2024
Accepted:
1 July 2024
Published:
23 July 2024
Abstract: Introduction: The prevalence of hypertension in children is much lower, around 1 to 5%. Clinical signs are still marked by accidents revealing neurological, cardiac and renal damage. The aim was to determine the epidemiological profile and prognosis of pediatric hypertension at the Ignace Deen National Hospital. Materials and methods: This was a prospective descriptive study of children and adolescents admitted to the pediatric ward of the Ignace Deen National Hospital during the period March 1 to August 31, 2021. All those aged 1 to 15 years declared hypertensive with mean systolic or diastolic blood pressure ≥ 95th percentile were included in this study. Results: Out of a total of 464 patients, our study included 12 cases, representing a 2.52% incidence of arterial hypertension; the mean age of our patients was 8 years ±2 years; males predominated, with a sex ratio equal to 2; physical signs were marked by edema of the lower limbs (66.67%); Immediately threatening hypertension represented 41.67%; hypertensive retinopathy was found in 33.33% of patients; 16.67% of patients presented with LVH; 25%; renal complications were 25%; mortality was of the same order 25%. Conclusion: The complications of pediatric hypertension are a real public health problem, with a high morbidity and mortality rate.
Abstract: Introduction: The prevalence of hypertension in children is much lower, around 1 to 5%. Clinical signs are still marked by accidents revealing neurological, cardiac and renal damage. The aim was to determine the epidemiological profile and prognosis of pediatric hypertension at the Ignace Deen National Hospital. Materials and methods: This was a pr...
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Case Report
Anesthesia Management of a Child with Severe Pectus Excavatum Complicated with Heart Compression Displacement
Jiaqi Yang
,
Xuejie Li*
Issue:
Volume 10, Issue 3, September 2024
Pages:
128-131
Received:
24 June 2024
Accepted:
16 July 2024
Published:
6 August 2024
Abstract: We report the anesthesia management of a severe pectus excavatum with cardiac compression displacement under thoracoscopic correction with general anesthesia. Preoperative chest computed tomography showed that the lower end of the sternum was significantly depressed, and the distance between the depressed sternum and the spine was less than 2cm. The heart was obviously compressed and shifted to the left thoracic cavity. During the intraoperative reversal of the orthopedic plate, the blood flow velocity of the tricuspid valve increased to 87.9cm/s and showed a single peak. The transesophageal echocardiography indicated mild tricuspid valve regurgitant flow, and the blood pressure dropped rapidly. After the surgeon was informed of the situation, the orthopedic plate was quickly turned to the convex side up, and the locally depressed anterior chest wall was lifted up. Satisfactory correction of chest wall malformations.
Abstract: We report the anesthesia management of a severe pectus excavatum with cardiac compression displacement under thoracoscopic correction with general anesthesia. Preoperative chest computed tomography showed that the lower end of the sternum was significantly depressed, and the distance between the depressed sternum and the spine was less than 2cm. Th...
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Case Report
A Rare Case of Late Onset-Pompe’s Disease: Presented as Heart Failure
Issue:
Volume 10, Issue 3, September 2024
Pages:
132-135
Received:
4 July 2024
Accepted:
24 July 2024
Published:
15 August 2024
Abstract: Pompe disease is a hereditary lysosomal storage disorder characterized by a deficiency in the acid alpha-glucosidase (GAA) enzyme, leading to glycogen accumulation in muscle and neurons. Clinical manifestations vary from severe infantile-onset with hypertrophic cardiomyopathy and early mortality due to respiratory insufficiency to late-onset with proximal muscle weakness, gross motor delay, and progressive respiratory insufficiency. A case of an 11-year-old boy who reported to the pediatric emergency department with a nine-year history of progressive muscle weakness and a one-month history of anemia symptoms (easy fatigue, shortness of breath, pale appearance) and heart failure (orthopnea, dyspnea). His family history included consanguineous marriages and similar conditions in his brother and maternal uncle. On examination, he appeared pale, malnourished, and exhibited signs of respiratory distress and tachypnea. His cardiovascular examination revealed apex beat displacement, elevated JVP, bilateral pedal edema, mild ascites, positive hepatojugular reflux, and systolic murmurs. Respiratory examination indicated bilateral crepitation and wheezes. Musculoskeletal examination showed decreased muscle mass and power, especially in proximal muscles. Abdominal examination revealed hepatosplenomegaly and mild ascites. Radiological findings included an enlarged cardiac shadow with pleural effusion and bilateral radio-opaque shadows on chest x-ray, while echocardiography showed impaired left ventricular systolic function with mild to moderate mitral and tricuspid regurgitation. Laboratory tests indicated elevated aspartate aminotransferase, LDH, and creatine kinase levels, along with normocytic, normochromic anemia. Muscle biopsy from the hamstring revealed PAS stain positive granules. These clinical, radiological, and laboratory findings strongly suggest late-onset Pompe disease, marking this as potentially the second reported case in Pakistan.
Abstract: Pompe disease is a hereditary lysosomal storage disorder characterized by a deficiency in the acid alpha-glucosidase (GAA) enzyme, leading to glycogen accumulation in muscle and neurons. Clinical manifestations vary from severe infantile-onset with hypertrophic cardiomyopathy and early mortality due to respiratory insufficiency to late-onset with p...
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Research Article
PIMS-TS Complicating SARS-CoV-2 Infection: A Report of 10 Pediatric Cases
Sanae Ahchouch*,
Youssef Benechchehab,
Raja Arrab,
Inssaf Al Ammari,
Nouzha Dini
Issue:
Volume 10, Issue 3, September 2024
Pages:
136-146
Received:
18 May 2024
Accepted:
18 July 2024
Published:
20 August 2024
Abstract: SARS-CoV-2, or COVID-19, is a betacoronavirus identified by the WHO as the cause of the 2020 pandemic. Unlike most respiratory virus, children exhibit lower susceptibility to COVID-19 and generally develop milder disease courses, with reduced mortality rates. Recently, there have been reports of clustered cases characterized by shock states associated with elevated cardiac biomarkers and vasoplegia, necessitating treatment with inotropes, vasopressors, and fluid resuscitation. This clinical presentation has been linked to the emergence of Pediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 (PIMS-TS), also known as Kawasaki-like syndrome. This study is a retrospective analysis of 10 pediatric patients diagnosed with PIMS-TS secondary to COVID-19 infection, who were admitted to Mohammed VI International University Hospital in Casablanca, Morocco, from January 2021 to October 2023. The cohort's ages ranged from 2 to 13 years, with a mean age of 6 years, and demonstrated a male predominance (sex ratio 9M:1F). Clinical manifestations included prolonged fever, gastrointestinal disturbances, rash, conjunctivitis, and cheilitis. Laboratory findings revealed elevated levels of CRP, PCT, and ferritin, indicative of an atypical Kawasaki syndrome. These patients responded to intravenous immunoglobulin therapy, with adjunctive corticosteroids administered as needed. All patients experienced favorable outcomes, with resolution of systemic involvement and normalization of inflammatory markers, and no relapses or fatalities were recorded. The risk factors for PIMS-TS complicating COVID-19 infection remain unclear. However, there are noted parallels between PIMS-TS and Kawasaki syndrome diagnostic criteria, suggesting possible pathophysiological overlap. In conclusion, a novel multisystem inflammatory syndrome associated with COVID-19 infection, resembling Kawasaki syndrome, has been identified in pediatric patients. This emerging syndrome enhances our understanding of the complex pathophysiology associated with COVID-19 and underscores the need for continued research into its etiology and optimal management strategies.
Abstract: SARS-CoV-2, or COVID-19, is a betacoronavirus identified by the WHO as the cause of the 2020 pandemic. Unlike most respiratory virus, children exhibit lower susceptibility to COVID-19 and generally develop milder disease courses, with reduced mortality rates. Recently, there have been reports of clustered cases characterized by shock states associa...
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Case Report
Cerebral Venous Thrombosis in Children: About 3 Cases
Imane Menjel*,
Abdelhakim Youssef Benmoussa,
Fatima Harim,
Imane Chahid,
Abdelhak Abkari
Issue:
Volume 10, Issue 3, September 2024
Pages:
147-151
Received:
11 June 2024
Accepted:
25 July 2024
Published:
27 August 2024
Abstract: The cerebral venous system is an unusual site for thrombosis. It is a rare pathology in children, with a considerable risk of morbidity and mortality in the absence of specific treatment. The incidence has increased over the last few decades due to improvements in neuroradiological techniques. Clinical features range from seizures, headache and respiratory distress to threatening focal neurological deficits and comatose state. The risk factors are age-dependent, frequently multiple and different from those reported in adults. Infections are the most common predisposing factor both in neonates and older children, followed by hypercoagulable/hematological states, dehydration and various other conditions. In majority of cases, it results from combination of prothombotic risk factors with or without underlying clinical condition. The prognosis is favorable in most cases if the diagnosis is made quickly and treatment is initiated promptly, although acute complications or chronic disability still occur in a quarter of patients. The mainstay of treatment is anticoagulation, which is needed to stop the clot spreading and recanalize it. Endovascular procedures are reserved for patients with a particularly severe presentation or rapidly developing neurological symptoms despite appropriate anticoagulation, although data from clinical trials is lacking. The aim of this work is to study the clinical, etiological, therapeutic and evolutionary characteristics of cerebral venous thrombosis (CVT) in the pediatric population.
Abstract: The cerebral venous system is an unusual site for thrombosis. It is a rare pathology in children, with a considerable risk of morbidity and mortality in the absence of specific treatment. The incidence has increased over the last few decades due to improvements in neuroradiological techniques. Clinical features range from seizures, headache and res...
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Case Report
The Particularities of Pulmonary Tuberculosis in Children with Type 1 Diabetes: About 2 Cases
Ilham Bouarab*,
Fatima Zahra Yakine,
Salma Tyhami,
Fatim Zahra Alaoui Inboui,
Bouchra Slaoui
Issue:
Volume 10, Issue 3, September 2024
Pages:
152-157
Received:
7 July 2024
Accepted:
9 August 2024
Published:
27 August 2024
Abstract: The combination of pulmonary tuberculosis and type 1 diabetes is a significant public health problem, especially in developing countries, where the incidence of both diseases is rising sharply. According to the World Health Organization (WHO), by 2022, 23% of tuberculosis cases will be in Africa. Morocco is one of the countries with a medium incidence of tuberculosis. The Ministry of Health has launched a national strategic plan for the prevention and control of tuberculosis. However, there is no national study on the prevalence of tuberculosis in diabetic children in Morocco. Several studies in the literature have investigated the specifics of this association, and have shown that there is a two-way association between tuberculosis and type 1 diabetes. Latent tuberculosis is most common in diabetic children, while active tuberculosis can give rise to severe and atypical presentations. In this study 2 cases have been reported of type 1 diabetes associated with pulmonary tuberculosis, of varying severity, in a 15-year-old child known to be diabetic and an 18-month-old infant with inaugural diabetes, in order to determine the clinical, paraclinical, therapeutic and evolutionary particularities of tuberculosis in these children.
Abstract: The combination of pulmonary tuberculosis and type 1 diabetes is a significant public health problem, especially in developing countries, where the incidence of both diseases is rising sharply. According to the World Health Organization (WHO), by 2022, 23% of tuberculosis cases will be in Africa. Morocco is one of the countries with a medium incide...
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Case Report
IgG4 Sclerosing Cholangitis: Entity Rarely Described in Children
Dalal Ben Sabbahia*,
Halima Msaaf,
Meriem Atrassi,
Sara Moukhlis,
Nissrine Bennani,
Abdelhak Abkari
Issue:
Volume 10, Issue 3, September 2024
Pages:
158-162
Received:
20 July 2024
Accepted:
12 August 2024
Published:
30 August 2024
DOI:
10.11648/j.ajp.20241003.19
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Abstract: IgG4-related sclerosing cholangitis (IgG4-SC) is known in the adult patients as a steroid-responsive biliary disease, frequently associated with autoimmune pancreatitis; The diagnosis of IgG4-SC may be difficult to differentiate from primary sclerosing cholangitis (PSC) or cholangiocarcinoma; This entity is been described in the absence of pancreatic implication. It is defined by high level of serum IgG4 in contrast to primary sclerosing cholangitis. It’is morphologically characterized by dense lymphoplasmacellular infiltration, particularly IgG4+ plasma cells and CD4+ T cells and extensive fibrosis in bile duct. In patients with IgG4-related sclerosing cholangitis, response to steroid therapy is high; in patients with PSC corticosteroid therapy is unsuccessful. An Early recognition of IgG4-SC can save patients from potential harmful and unnecessary surgical interventions. In the literature, cholangiocarcinoma in patients with IgG4- related sclerosing cholangitis was not described, whereas cholangiocarcinoma develops in up to 10-30% of patients with PSC. We present the case of a 3 years old child with features of sclerosing IgG4 cholangitis with asymptomatic elevation in liver enzymes, bile duct strictures on imaging, characteristic pathology findings, elevated serum IgG4, without signs of pancreatic involvement, and excellent response to corticosteroids. Pediatric gastroenterologists and hepatologists, as well as pediatric hepatopathologists, need to be aware of IgG4-SC as a disease entity.
Abstract: IgG4-related sclerosing cholangitis (IgG4-SC) is known in the adult patients as a steroid-responsive biliary disease, frequently associated with autoimmune pancreatitis; The diagnosis of IgG4-SC may be difficult to differentiate from primary sclerosing cholangitis (PSC) or cholangiocarcinoma; This entity is been described in the absence of pancreat...
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