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P123 – 2671: Follow up of neurodevelopmental outcome after therapeutic hypothermia for perinatal asphyxia
EUROPEAN JOURNAL O F PAEDIATRIC NEUROLOGY
be a way of evaluating the possible benefits of decompression of arachnoid cysts of the middle cranial fossa in children.
P123 - 2671 Follow up of neurodevelopmental outcome after therapeutic hypothermia for perinatal asphyxia S. Zubcevic, S. Heljic, F. Catibusic, S. Uzicanin, B. Krdzalic. Neuropaediatrician at Paediatric Hospital University Clinical Center, Sarajevo Objective: Neuroprotective benefit of therapeutic hypothermia in term newborns with hypoxic-ischemic encephalopathy was assessed by analyzing survival and neurodevelopmental outcome of neonates subjected to this procedure. Methods: Newborns with gestational age of more than 36 weeks and less than 6 hours of age with moderate to severe asphyxial encephalopathy underwent cooling protocol at a temperature of 33.5 °C for 72 hours and rewarming period of 6 hours. The outcome measures assessed were death and neurodevelopmental characteristics, which we compared at the different age using ASQ-3, at least 3 times during follow-up. Results: Twenty-five children were assessed during the period from October 2010 to October 2013. Median gestational age was 40 weeks, birth weight 3470 g, Apgar score 2/4 and pH on admission to the hospital 7.02. Four (16%) children died and two were lost for follow up. At the first assessment developmental categories of communication were normal in 68.4%, problem solving in 73.7%, personal-social in 68.4%, gross motor in 57.9%, and fine motor in 36.8% but with a high need of retesting in this area. Seven of 19 patients (36.8%) had completely normal results for all five categories, while three (15.8%) had abnormal results for all categories. Second assesment was done in 17 patients with developmental categories of communication normal in 70.5%, problem solving in 76.5%, personal-social in 70.5%, gross motor in 58.8%, and fine motor in 41.1%. Third evaluation was done in 13 patients: developmental categories of communication were normal in 69.2%, problem solving in 76.9%, personal-social in 69.2%, gross motor in 61.5%, and fine motor in 46.2%. Conclusion: Relatively small number of patients and limitations of this study design precluded any far-reaching conclusions, but we think that therapeutic hypothermia in term newborns can provide better survival and less neurologic sequels in hypoxic-ischemic encephalopathy patients.
P124 - 2714 Pseudotumor cerebri in a child with familial Mediterranean fever F. Incecik 1 , O.M. Hergüner 1 , S. Besen 1 , E. Aynaci 1 , M. Yilmaz 2 , S. Altunba¸sak 1 . 1 Division of Pediatric Neurology; 2 Division of Pediatric Immunology, Department of Pediatrics, Çukurova University Faculty of Medicine, Adana, Turkey Objective: Familial Mediterranean fever (FMF) is an autosomal recessive polysystemic disease characterized by attacks of relapsing and self-limiting fever, peritonitis, pleuritis and arthritis. Neurologic involvement is rare but serious in FMF. Headache, seizures, demyelinating lesions, stroke, posterior reversible leukoencephalopathy syndrome, aseptic meningitis, convulsions, and cranial neuropathy have been reported in previously literature. Methods: We reported a 10 year-old boy with pseudotumor cerebri and FMF. Results: We treated acetozolamide. After treatment, we described a dramatic improvement of his neurological symptoms. Conclusion: Pseudotumor cerebri may be a manifestation of FMF in children. Early diagnosis is important for preserving visual functions.
19s (2015) S1 – S152
S129
P125 - 2716 A presentation of Lyme disease: Pseudotumor cerebri B. Sahin 1 , F. Incecik 1 , O.M. Hergüner 1 , D. Alabaz 2 , S. Besen 1 , E. Aynaci 1 , S. Altunba¸sak 1 . 1 Division of Pediatric Neurology; 2 Division of Pediatric Infectious Diseases, Department of Pediatrics, Çukurova University Faculty of Medicine, Adana, Turkey Objective: Lyme disease is caused by a tick-transmitted spirochete, Borrelia burgdorfer. It can present with both central and peripheral nervous system manifestations, including aseptic meningitis, meningoencephalitis, pseudotumor cerebri, Bell’s palsy and other cranial neuropathies, radiculoneuritis, and myelitis. Methods: We reported a 8 year-old girl with pseudotumor cerebri secondary to Lyme disease. Results: We treated ceftriaxone per day for the next 4 weeks, and acetozolamide. After teratment, her neurologic examination was normal. Conclusion: Pseudotumor cerebri is a rare B. Burgdorferie related neurologic complication in childhood. Lyme disease should be included in the differential diagnosis of any child who presents with pseudotumor cerebri.
P126 - 2738 Non-thyroidal illness associated with aseptic meningitis in a child D. Poorva Rathod, D. Adeline Ngoh, D. Deepa Krishnakumar, M. Chitre. Addenbrookes University Hospital Background: Non-thyroidal illness syndrome (NITS) or sick euthyroid syndrome is a maladaptive state of abnormal thyroid hormone function in critically ill patients. Previous studies have demonstrated the presence of this condition in children with severe sepsis eg meningococcal septicaemia and after cardiac surgery. We report the first case of non-thyroidal illness syndrome in a child with aseptic meningitis. Case presentation: A previously well 11 year old child presented with fever and cough. He was started on oral antibiotics for presumed chest infection. A week later he developed headache, vomiting and increased daytime somnolence; features consistent with encephalopathy. He had mild neck stiffness and fluctuating GCS of 9–10. He was notably bradycardic, (heart rate 38bpm, sinus rhythm) with poor urine output. Lumbar puncture showed 30 polymorphs, no organisms on Gram-Stain or culture. His viral PCR was negative. A brain MRI with contrast was normal. Further investigations revealed a low TSH (0.32 mU/L), low fT3 (2 pmol/L). Fasting cortisol level was normal. NMDA and VGKC antibodies were negative. He was diagnosed with a non-thyroidal illness syndrome with aseptic meningitis and managed conservatively. He was given IV antibiotics, fluid and calorie intake was optimised. Neurological status was closely monitored. His encephalopathy gradually improved as did the urine output, bradycardia and thyroid function. Discussion: In severe sepsis, previously normal thyroid function may become suppressed. Studies comparing thyroid function in children suffering from bacterial and viral meningitis, have shown a more significant decrease in the levels of thyroid hormones (especially TSH and fT3) at the beginning of bacterial meningitis. Previous literature shows that early initiation of oral/enteral nutrition in these patients, improves thyroid hormone status without the need for replacement therapy. Paediatricians and paediatric neurologists need to be aware of this rare condition. Empirical treatment with corticosteroids or thyroid replacement therapy is not required.
be a way of evaluating the possible benefits of decompression of arachnoid cysts of the middle cranial fossa in children.
P123 - 2671 Follow up of neurodevelopmental outcome after therapeutic hypothermia for perinatal asphyxia S. Zubcevic, S. Heljic, F. Catibusic, S. Uzicanin, B. Krdzalic. Neuropaediatrician at Paediatric Hospital University Clinical Center, Sarajevo Objective: Neuroprotective benefit of therapeutic hypothermia in term newborns with hypoxic-ischemic encephalopathy was assessed by analyzing survival and neurodevelopmental outcome of neonates subjected to this procedure. Methods: Newborns with gestational age of more than 36 weeks and less than 6 hours of age with moderate to severe asphyxial encephalopathy underwent cooling protocol at a temperature of 33.5 °C for 72 hours and rewarming period of 6 hours. The outcome measures assessed were death and neurodevelopmental characteristics, which we compared at the different age using ASQ-3, at least 3 times during follow-up. Results: Twenty-five children were assessed during the period from October 2010 to October 2013. Median gestational age was 40 weeks, birth weight 3470 g, Apgar score 2/4 and pH on admission to the hospital 7.02. Four (16%) children died and two were lost for follow up. At the first assessment developmental categories of communication were normal in 68.4%, problem solving in 73.7%, personal-social in 68.4%, gross motor in 57.9%, and fine motor in 36.8% but with a high need of retesting in this area. Seven of 19 patients (36.8%) had completely normal results for all five categories, while three (15.8%) had abnormal results for all categories. Second assesment was done in 17 patients with developmental categories of communication normal in 70.5%, problem solving in 76.5%, personal-social in 70.5%, gross motor in 58.8%, and fine motor in 41.1%. Third evaluation was done in 13 patients: developmental categories of communication were normal in 69.2%, problem solving in 76.9%, personal-social in 69.2%, gross motor in 61.5%, and fine motor in 46.2%. Conclusion: Relatively small number of patients and limitations of this study design precluded any far-reaching conclusions, but we think that therapeutic hypothermia in term newborns can provide better survival and less neurologic sequels in hypoxic-ischemic encephalopathy patients.
P124 - 2714 Pseudotumor cerebri in a child with familial Mediterranean fever F. Incecik 1 , O.M. Hergüner 1 , S. Besen 1 , E. Aynaci 1 , M. Yilmaz 2 , S. Altunba¸sak 1 . 1 Division of Pediatric Neurology; 2 Division of Pediatric Immunology, Department of Pediatrics, Çukurova University Faculty of Medicine, Adana, Turkey Objective: Familial Mediterranean fever (FMF) is an autosomal recessive polysystemic disease characterized by attacks of relapsing and self-limiting fever, peritonitis, pleuritis and arthritis. Neurologic involvement is rare but serious in FMF. Headache, seizures, demyelinating lesions, stroke, posterior reversible leukoencephalopathy syndrome, aseptic meningitis, convulsions, and cranial neuropathy have been reported in previously literature. Methods: We reported a 10 year-old boy with pseudotumor cerebri and FMF. Results: We treated acetozolamide. After treatment, we described a dramatic improvement of his neurological symptoms. Conclusion: Pseudotumor cerebri may be a manifestation of FMF in children. Early diagnosis is important for preserving visual functions.
19s (2015) S1 – S152
S129
P125 - 2716 A presentation of Lyme disease: Pseudotumor cerebri B. Sahin 1 , F. Incecik 1 , O.M. Hergüner 1 , D. Alabaz 2 , S. Besen 1 , E. Aynaci 1 , S. Altunba¸sak 1 . 1 Division of Pediatric Neurology; 2 Division of Pediatric Infectious Diseases, Department of Pediatrics, Çukurova University Faculty of Medicine, Adana, Turkey Objective: Lyme disease is caused by a tick-transmitted spirochete, Borrelia burgdorfer. It can present with both central and peripheral nervous system manifestations, including aseptic meningitis, meningoencephalitis, pseudotumor cerebri, Bell’s palsy and other cranial neuropathies, radiculoneuritis, and myelitis. Methods: We reported a 8 year-old girl with pseudotumor cerebri secondary to Lyme disease. Results: We treated ceftriaxone per day for the next 4 weeks, and acetozolamide. After teratment, her neurologic examination was normal. Conclusion: Pseudotumor cerebri is a rare B. Burgdorferie related neurologic complication in childhood. Lyme disease should be included in the differential diagnosis of any child who presents with pseudotumor cerebri.
P126 - 2738 Non-thyroidal illness associated with aseptic meningitis in a child D. Poorva Rathod, D. Adeline Ngoh, D. Deepa Krishnakumar, M. Chitre. Addenbrookes University Hospital Background: Non-thyroidal illness syndrome (NITS) or sick euthyroid syndrome is a maladaptive state of abnormal thyroid hormone function in critically ill patients. Previous studies have demonstrated the presence of this condition in children with severe sepsis eg meningococcal septicaemia and after cardiac surgery. We report the first case of non-thyroidal illness syndrome in a child with aseptic meningitis. Case presentation: A previously well 11 year old child presented with fever and cough. He was started on oral antibiotics for presumed chest infection. A week later he developed headache, vomiting and increased daytime somnolence; features consistent with encephalopathy. He had mild neck stiffness and fluctuating GCS of 9–10. He was notably bradycardic, (heart rate 38bpm, sinus rhythm) with poor urine output. Lumbar puncture showed 30 polymorphs, no organisms on Gram-Stain or culture. His viral PCR was negative. A brain MRI with contrast was normal. Further investigations revealed a low TSH (0.32 mU/L), low fT3 (2 pmol/L). Fasting cortisol level was normal. NMDA and VGKC antibodies were negative. He was diagnosed with a non-thyroidal illness syndrome with aseptic meningitis and managed conservatively. He was given IV antibiotics, fluid and calorie intake was optimised. Neurological status was closely monitored. His encephalopathy gradually improved as did the urine output, bradycardia and thyroid function. Discussion: In severe sepsis, previously normal thyroid function may become suppressed. Studies comparing thyroid function in children suffering from bacterial and viral meningitis, have shown a more significant decrease in the levels of thyroid hormones (especially TSH and fT3) at the beginning of bacterial meningitis. Previous literature shows that early initiation of oral/enteral nutrition in these patients, improves thyroid hormone status without the need for replacement therapy. Paediatricians and paediatric neurologists need to be aware of this rare condition. Empirical treatment with corticosteroids or thyroid replacement therapy is not required.