- Email: [email protected]
P129 – 1592 Isolated sphenoid sinusitis masquerading migraine
S88
E U R O P E A N JO U R N A L O F PAEDIATRIC N E U R O L O G Y
P125 - 1700 MRI pattern recognition for congenital CMV Aleksanyan A, Yepiskoposian M. Arabkir Joint Medical Center, Yerevan, Armenia – [email protected] Introduction: This report describes a case in which MRI pictures lead to diagnosis of Congenital CMV. Case presentation: 2 months old infant was hospitalized because of diffuse skin lesions. He is 1st child from 1st pregnancy, child was born at term, with low birth weight. He had microcephaly, severe spasticity, high tendon reflexes, restriction of hip abduction and he was underweight. Bilateral sensorineural hearing loss was revealed by audiometry and hepatic cyst was found by ultrasonography. MRI was done and diffuse white matter changes, bilateral temporal cysts, abnormal gyration, intraventricular septae were found in it. It was suspested CMV and then it was confirmed by PCR in dry blood of Gurthrie card taken for screening purposes. Conclusion: The presence of the described MRI findings is an indication for CMV investigation. And MRI with such changes can be pattern recognition for Congenital CMV.
P126 - 1693 Paediatric sciatic neuropathy presenting as painful leg: a case report and review of literature Iqbal M, Prasad M, Babiker M, Ritey C. Sheffield Childrens Hospital, Sheffield, UK – [email protected] Introduction: Mononeuropathies in general are very uncommon in childhood. Sciatic neuropathy (SN) is probably underappreciated in childhood and likely to represent nearly one quarter of childhood mononeuropathies. Method: We present a 7 old girl who presented with painful right lower limb and abnormal gait. Detailed investigation revealed transient eosinophilia, abnormal neurophysiology and MRI suggestive of isolated sciatic neuropathy. Results: She has responded very well to physiotherapy and has made a complete motor recovery although she is left with an area of abnormal sensation affecting the lateral border of her right leg and the dorsum of her foot. Discussion: Differential diagnoses for paediatric SN will be discussed including compressive neuropathies in children and various hyper-eosinophilia syndromes. Compressive neuropathies in childhood are very rare and compression of the sciatic nerve is the second most common group after peroneal nerve lesion.
17s (2013) S1 – S149
severe form of PANDAS-like condition finally leading to residual epilepsy, cognitive deficits and depression.
P128 - 1627 Overview of pediatric peripheral facial nerve paralysis: analysis of 40 patients Ozkale Y, Erol I, Saygi S, Yılmaz I. Baskent University Faculty of Medicine, Department of Pediatrics, Adana Teaching and Medical Research Center, Turkey – [email protected] Objectives: Peripheral facial nerve paralysis (PFNP) in children might be alarming sign of serious disease such as malignancy, systemic disease, congenital anomalies, trauma, infection, middle ear surgery and hypertension. It may also be caused due to immunization and toxic factors or Bell’s palsy. Therefore, careful investigation and differental diagnosis are essential in children. Material and methods: The cases of 40 consecutive children, and adolescents who diagnosed as PFNP at Baskent University Adana Hospital Pediatrics and Pediatric Neurology Unit between January 2010 and January 2013 were retrospectively evaluated. Results: There were 15 boys and 25 girls, age range, 2 months to 17 years (with a median age, 6.5±4.51 years). All of the patients had acquired, first episode and unilateral PFNP. As regards the etiology of PFNP in children, we determined the most common cause was Bell’s palsy (26 cases, 65%), fallowed by infection (11 cases, 37.5%), tumor lesion (1 case, 2.5%), suspected chemotheraphy toxicty (1 case 2.5%). In the infectious group; 5 patients with PFNP had otitis media from clinical examination. Seven children had serological evidence of specific triggers: Borellia Burgdorferi (3); herpes simplex virus (3), mycoplasma (1). Thirty one patients with facial nerve paralysis were treated with oral steriods. We also didn’t reveal a significant difference in the outcome of facial nerve paralysis between treated and not treated groups. We noted that younger patients had generally poor outcome than older patients with regardless of disease etiology. Conclusion: PFNP has been reported in many countries from America and Europe, however, knowledge about its clinical features, microbiology, neuroimaging, and treatment in Turkey is incomplete. Present study demonstrated that Bell’s palsy, infection and trauma were the most most common etiologies of PFNP in Southern coast of Anatolia (Mediterranean region).
P129 - 1592 Isolated sphenoid sinusitis masquerading migraine
P127 - 1650 Severe PANDAS-like course: a case report Cindro Heberle L, Pavlovic´ M, Neubauer D, Al Tawari A. Al Sabah Hospital, Pediatric Department, Kuwait – [email protected] Objective: clinical spectrum of autoimmune disorders following infection with group A beta-hemolytic streptococcus may extend beyond Syndenham chorea and PANDAS. We report a boy with life-threatening course improved after immunotherapy. Case presentation: 11 years old boy with 1 year long history of facial tics developed fever with throat infection progressing to lethargy and epileptic status stopped by anticonvulsants but severe agitation, fidgetting and frequent tics were observed afterwards, soon to be followed by another epileptic status and central apneas requiring intubation and intensive care for several days. Virology work up and CSF study were normal, high titers of ASOT (3200 IU/ml) were found. EEG detected slow background activity, on MRI brain subtle thalamic changes were seen. Treated by antibiotics, immunoglobulins, methyl-prednisolone and antiepileptics the child gradually improved but cognitive impairment (IQ 68), depressive behavior, tics and occasional focal seizures have remained. Conclusions: we believe that the boy had an extremely
Jeong-Ho L, Suh ES. Department of Pediatrics, College of Medicine, Soonchunhyang University Hospital, Seoul, Korea – [email protected] Objective: Sinusitis is a well-known cause of headache, with an incidence of around 9% among children and adolescents. But, isolated sphenoid sinusitis is a rare disease and its symptoms are often non-specific and confusing. So the diagnosis can be difficult to differentiate from migraine headache. But there are few reports of isolated sphenoid sinusitis and headaches in children. Results: Case 1: A 10-year-old boy was referred for evaluation of migraine headaches. Headache with diplopia started 6 months ago. His headaches were located at both parietal area associated with photophobia, lasting 1–2 hours. Events were occurred nearly every day, occasionally relieved by sleep. He was afebrile without evidence of nasal congestion or facial tenderness over his sinuses. His neurologic and ophthalmologic examinations were normal. The brain magnetic resonance (MRI) showed isolated Right sphenoid sinusitis. After oral antibiotic treatment for 3 weeks, his symptoms were relieved and follow up MRI showed improved sinusitis. Case 2: A 8-year-old female presented with a 2 weeks history of severe headache with dizziness, nausea. Her mother has the migraine history. She denied any nasal symptoms or fever. The headaches were described as both sided, constant
E U R O P E A N JO U R N A L O F PAEDIATRIC N E U R O L O G Y
and throbbling, exacerbated with head movement, lasting 1 hour. Her neurologic examination was normal and no tenderness on sinuses area. MRI was requested to rule out intracranial pathology and revealed isolated sphenoid sinusitis. After one month oral medication, her headaches were relieved. Conclusion: Two children who presented for suspected migraine headaches had isolated sphenoid sinusitis.
17s (2013) S1 – S149
S89
IgG index (1.1) and was oligoclonal band-negative. A two-month follow-up magnetic resonance imaging revealed cerebellar atrophy and remaining subtle signal changes in the cerebellum, albeit the patient showed no neurologic deficit.
P132 - 1525 Initial and hospital-acquired hyponatremia in children with CNS infection
P130 - 1577 A case of brain abscess arising from sinusitis Lee BL. Department of Pediatrics, Pusan Paik Hospital, Inje University College of Medicine, Busan, Korea – [email protected] Introduction: Brain abscess is regarded as a significant intracranial complication of bacterial sinusitis. We report a case of cerebritis proceeded by acute sinusitis which progressed into a large abscess in spite of adequate empirical antibiotic therapy and sinus drainage. Cases: A 13-year-old girl was admitted to our hospital with pyrexia and headache. She had past history of chronic sinusitis. On examination, she had neck stiffness, but there was no focal neurologic deficit. Laboratory findings revealed a neutrophilia. Computed tomography of the brain identified a sphenoid sinusitis, but there was no other abnormal finding. A spinal tap showed normal cerebrospinal fluid. Empirical antibiotic therapy with cefotaxime was initiated. However, fever and headache were aggravated. Brain magnetic resonance imaging (MRI) performed on five days after admission revealed cerebritis of right frontal lobe, small abscess formation (<1 cm) in connection with anterior skull base wall and ethmoid and sphenoid sinusitis. Vancomycin and metronidazole were empirically added, and functional endoscopic sinus surgery (FESS) was done for sinus drainage. Bacterial culture from drainage presented Staphylococcus aures. However, in spite of appropriate antibiotic therapy and FESS, her fever and headache appeared again after two weeks. Follow-up MRI showed enlarged rim enhancing lesion in right frontal lobe with central cystic necrosis (about 4.4×2.5 cm). A prompt neurosurgical bur hole aspiration was performed. Postoperatively, her symptoms were improved and intravenous antibiotics were continued for 6 weeks. MRI performed four weeks after operation showed a nearly improving state of abscess. No recurrence was noted during the 6-month follow-up period, and she remained free of neurologic deficit. Conclusion: Intracranial complication secondary to sinusitis can be progressed to be potentially life threatening despite the appropriate use of broad-spectrum antibiotics. Therefore, a high degree of suspicion, along with serial neuroimaging and prompt neurosurgical intervention, is required.
P131 - 1553 Acute cerebellitis presenting with sudden onset headache accompanied by elevated CSF IgG index Lee KY. Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Korea – [email protected] Acute cerebellitis, a rare inflammatory syndrome of the cerebellum, is one of the important causes of acute cerebellar dysfunction in childhood. Although it typically presents with cerebellar dysfunction such as ataxia, non-localizing symptoms such as headache can be much more prominent than cerebellar symptoms because of increased intracranial pressure as a result of cerebellar swelling. The cerebrospinal fluid (CSF) IgG index is most often tested clinically in the diagnosis of multiple sclerosis. However, it is not specific to multiple sclerosis, and can be elevated in a variety of neurologic diseases, including bacterial and viral central nervous system infections. A 7-year-old boy with acute cerebellitis presenting with sudden onset headache and only subtle cerebellar dysfunction demonstrated an elevated CSF
Lee YJ, Yeon GM, Nam SO, Kim YM. Department of Pediatrics, Pusan National University Children’s Hospital, Yangsan-si, Korea – [email protected] Purpose: The aim of this study was to compare the effect of the different etiologies in the children with CNS infection on the incidence of initial vs hospital-acquired hyponatremia (IH vs HAH) (plasma sodium concentration, PNa <135 mmol/L). Methods: Children who treated for CNS infection and required the administration of intravenous fluid between 2011 and 2012 were evaluated retrospectively. The children were classified into 4 groups: group A of aseptic meningitis, group B of viral meningoencephalitis, group C of bacterial meningitis, and group D of tuberculous meningitis. All patients had measured the initial PNa and were retested serially. By the sodium concentration of fluid, children were divided into 2 groups: group I of the under 0.45% saline in dextrose, and group II of more than 0.45% saline. Results: We identified 248 children (185 in group A, 33 in group B, 27 in group C, and 3 in group D). The mean age was younger in children of group C (3.5±5.3 years) (p=0.0124) than in those of group A (5.7±3.9 years) or group B (6.3±5.5 years). IH and HAH was found in 13.3% (33/248) and 10.1% (25/248) of all patients, respectively. The incidence of IH was significantly higher in group C (8/27, 29.6%) (p=0.0082) than in group A (17/185, 9.2%) or group B (7/33, 21.2%). HAH was more frequent in group B (9/33, 27.3%) (p=0.0004) and in group D (2/3, 66.7%) (p=0.0011) than in group A (9/185, 4.9%) (p<0.0001) or in group C (5/27, 18.5%) (p=0.1229). Of the patients in group I, 27.6% (8/29) developed more common HAH compared with 7.8% (17/219) in group II (p=0.0009). Any hyponatremia was not noted in 82.2% (180/219) in group II during the period of hospitalization (p<0.0001). Conclusion: Hyponatremia was common in children with CNS infection, and the incidence showed distinct differences among the different etiologies. The administration of more than 0.45% saline could help in reducing the incidence of HAH in children with CNS infection.
P133 - 1513 Clinical application of viral CSF PCR studies: a retrospective 11-year experience Kleines M, Scheithauer S, Schiefer J, Häusler M. Department of Infection Control and Infectious Diseases, University Hospital RWTH Aachen, Germany – [email protected] Background: The PCR is the method of choice to detect viral activity in the central nervous system (CNS). Positive findings, however, do not prove an impact on the neurological problem. Here, knowledge on large patient groups may facilitate data interpretation. Methods: A retrospective analysis of CSF PCR data concerning 514 pediatric and 2904 adult samples, focusing on Epstein-Barr virus (EBV), cytomegalovirus (CMV), herpes simplex virus (HSV), enteroviruses (ENV), human herpesvirus type 6 (HHV-6) and varicella zoster virus (VZV). Results: EBV was detected in 1.63%, VZV in 1.3%, HSV in 0.4%, ENV in 0.4%, CMV in 0.2% and HHV-6 in 0.2% of the patients studied, respectively. Detection rates were higher among very young and among older patients. HSV, VZV and ENV were dominant in typical infectious CNS diseases, EBV in further inflammatory diseases (bacterial CNS infections, multiple sclerosis, HIV infection) and in diseases not typically attributed to infections. HSV and VZV were frequent
E U R O P E A N JO U R N A L O F PAEDIATRIC N E U R O L O G Y
P125 - 1700 MRI pattern recognition for congenital CMV Aleksanyan A, Yepiskoposian M. Arabkir Joint Medical Center, Yerevan, Armenia – [email protected] Introduction: This report describes a case in which MRI pictures lead to diagnosis of Congenital CMV. Case presentation: 2 months old infant was hospitalized because of diffuse skin lesions. He is 1st child from 1st pregnancy, child was born at term, with low birth weight. He had microcephaly, severe spasticity, high tendon reflexes, restriction of hip abduction and he was underweight. Bilateral sensorineural hearing loss was revealed by audiometry and hepatic cyst was found by ultrasonography. MRI was done and diffuse white matter changes, bilateral temporal cysts, abnormal gyration, intraventricular septae were found in it. It was suspested CMV and then it was confirmed by PCR in dry blood of Gurthrie card taken for screening purposes. Conclusion: The presence of the described MRI findings is an indication for CMV investigation. And MRI with such changes can be pattern recognition for Congenital CMV.
P126 - 1693 Paediatric sciatic neuropathy presenting as painful leg: a case report and review of literature Iqbal M, Prasad M, Babiker M, Ritey C. Sheffield Childrens Hospital, Sheffield, UK – [email protected] Introduction: Mononeuropathies in general are very uncommon in childhood. Sciatic neuropathy (SN) is probably underappreciated in childhood and likely to represent nearly one quarter of childhood mononeuropathies. Method: We present a 7 old girl who presented with painful right lower limb and abnormal gait. Detailed investigation revealed transient eosinophilia, abnormal neurophysiology and MRI suggestive of isolated sciatic neuropathy. Results: She has responded very well to physiotherapy and has made a complete motor recovery although she is left with an area of abnormal sensation affecting the lateral border of her right leg and the dorsum of her foot. Discussion: Differential diagnoses for paediatric SN will be discussed including compressive neuropathies in children and various hyper-eosinophilia syndromes. Compressive neuropathies in childhood are very rare and compression of the sciatic nerve is the second most common group after peroneal nerve lesion.
17s (2013) S1 – S149
severe form of PANDAS-like condition finally leading to residual epilepsy, cognitive deficits and depression.
P128 - 1627 Overview of pediatric peripheral facial nerve paralysis: analysis of 40 patients Ozkale Y, Erol I, Saygi S, Yılmaz I. Baskent University Faculty of Medicine, Department of Pediatrics, Adana Teaching and Medical Research Center, Turkey – [email protected] Objectives: Peripheral facial nerve paralysis (PFNP) in children might be alarming sign of serious disease such as malignancy, systemic disease, congenital anomalies, trauma, infection, middle ear surgery and hypertension. It may also be caused due to immunization and toxic factors or Bell’s palsy. Therefore, careful investigation and differental diagnosis are essential in children. Material and methods: The cases of 40 consecutive children, and adolescents who diagnosed as PFNP at Baskent University Adana Hospital Pediatrics and Pediatric Neurology Unit between January 2010 and January 2013 were retrospectively evaluated. Results: There were 15 boys and 25 girls, age range, 2 months to 17 years (with a median age, 6.5±4.51 years). All of the patients had acquired, first episode and unilateral PFNP. As regards the etiology of PFNP in children, we determined the most common cause was Bell’s palsy (26 cases, 65%), fallowed by infection (11 cases, 37.5%), tumor lesion (1 case, 2.5%), suspected chemotheraphy toxicty (1 case 2.5%). In the infectious group; 5 patients with PFNP had otitis media from clinical examination. Seven children had serological evidence of specific triggers: Borellia Burgdorferi (3); herpes simplex virus (3), mycoplasma (1). Thirty one patients with facial nerve paralysis were treated with oral steriods. We also didn’t reveal a significant difference in the outcome of facial nerve paralysis between treated and not treated groups. We noted that younger patients had generally poor outcome than older patients with regardless of disease etiology. Conclusion: PFNP has been reported in many countries from America and Europe, however, knowledge about its clinical features, microbiology, neuroimaging, and treatment in Turkey is incomplete. Present study demonstrated that Bell’s palsy, infection and trauma were the most most common etiologies of PFNP in Southern coast of Anatolia (Mediterranean region).
P129 - 1592 Isolated sphenoid sinusitis masquerading migraine
P127 - 1650 Severe PANDAS-like course: a case report Cindro Heberle L, Pavlovic´ M, Neubauer D, Al Tawari A. Al Sabah Hospital, Pediatric Department, Kuwait – [email protected] Objective: clinical spectrum of autoimmune disorders following infection with group A beta-hemolytic streptococcus may extend beyond Syndenham chorea and PANDAS. We report a boy with life-threatening course improved after immunotherapy. Case presentation: 11 years old boy with 1 year long history of facial tics developed fever with throat infection progressing to lethargy and epileptic status stopped by anticonvulsants but severe agitation, fidgetting and frequent tics were observed afterwards, soon to be followed by another epileptic status and central apneas requiring intubation and intensive care for several days. Virology work up and CSF study were normal, high titers of ASOT (3200 IU/ml) were found. EEG detected slow background activity, on MRI brain subtle thalamic changes were seen. Treated by antibiotics, immunoglobulins, methyl-prednisolone and antiepileptics the child gradually improved but cognitive impairment (IQ 68), depressive behavior, tics and occasional focal seizures have remained. Conclusions: we believe that the boy had an extremely
Jeong-Ho L, Suh ES. Department of Pediatrics, College of Medicine, Soonchunhyang University Hospital, Seoul, Korea – [email protected] Objective: Sinusitis is a well-known cause of headache, with an incidence of around 9% among children and adolescents. But, isolated sphenoid sinusitis is a rare disease and its symptoms are often non-specific and confusing. So the diagnosis can be difficult to differentiate from migraine headache. But there are few reports of isolated sphenoid sinusitis and headaches in children. Results: Case 1: A 10-year-old boy was referred for evaluation of migraine headaches. Headache with diplopia started 6 months ago. His headaches were located at both parietal area associated with photophobia, lasting 1–2 hours. Events were occurred nearly every day, occasionally relieved by sleep. He was afebrile without evidence of nasal congestion or facial tenderness over his sinuses. His neurologic and ophthalmologic examinations were normal. The brain magnetic resonance (MRI) showed isolated Right sphenoid sinusitis. After oral antibiotic treatment for 3 weeks, his symptoms were relieved and follow up MRI showed improved sinusitis. Case 2: A 8-year-old female presented with a 2 weeks history of severe headache with dizziness, nausea. Her mother has the migraine history. She denied any nasal symptoms or fever. The headaches were described as both sided, constant
E U R O P E A N JO U R N A L O F PAEDIATRIC N E U R O L O G Y
and throbbling, exacerbated with head movement, lasting 1 hour. Her neurologic examination was normal and no tenderness on sinuses area. MRI was requested to rule out intracranial pathology and revealed isolated sphenoid sinusitis. After one month oral medication, her headaches were relieved. Conclusion: Two children who presented for suspected migraine headaches had isolated sphenoid sinusitis.
17s (2013) S1 – S149
S89
IgG index (1.1) and was oligoclonal band-negative. A two-month follow-up magnetic resonance imaging revealed cerebellar atrophy and remaining subtle signal changes in the cerebellum, albeit the patient showed no neurologic deficit.
P132 - 1525 Initial and hospital-acquired hyponatremia in children with CNS infection
P130 - 1577 A case of brain abscess arising from sinusitis Lee BL. Department of Pediatrics, Pusan Paik Hospital, Inje University College of Medicine, Busan, Korea – [email protected] Introduction: Brain abscess is regarded as a significant intracranial complication of bacterial sinusitis. We report a case of cerebritis proceeded by acute sinusitis which progressed into a large abscess in spite of adequate empirical antibiotic therapy and sinus drainage. Cases: A 13-year-old girl was admitted to our hospital with pyrexia and headache. She had past history of chronic sinusitis. On examination, she had neck stiffness, but there was no focal neurologic deficit. Laboratory findings revealed a neutrophilia. Computed tomography of the brain identified a sphenoid sinusitis, but there was no other abnormal finding. A spinal tap showed normal cerebrospinal fluid. Empirical antibiotic therapy with cefotaxime was initiated. However, fever and headache were aggravated. Brain magnetic resonance imaging (MRI) performed on five days after admission revealed cerebritis of right frontal lobe, small abscess formation (<1 cm) in connection with anterior skull base wall and ethmoid and sphenoid sinusitis. Vancomycin and metronidazole were empirically added, and functional endoscopic sinus surgery (FESS) was done for sinus drainage. Bacterial culture from drainage presented Staphylococcus aures. However, in spite of appropriate antibiotic therapy and FESS, her fever and headache appeared again after two weeks. Follow-up MRI showed enlarged rim enhancing lesion in right frontal lobe with central cystic necrosis (about 4.4×2.5 cm). A prompt neurosurgical bur hole aspiration was performed. Postoperatively, her symptoms were improved and intravenous antibiotics were continued for 6 weeks. MRI performed four weeks after operation showed a nearly improving state of abscess. No recurrence was noted during the 6-month follow-up period, and she remained free of neurologic deficit. Conclusion: Intracranial complication secondary to sinusitis can be progressed to be potentially life threatening despite the appropriate use of broad-spectrum antibiotics. Therefore, a high degree of suspicion, along with serial neuroimaging and prompt neurosurgical intervention, is required.
P131 - 1553 Acute cerebellitis presenting with sudden onset headache accompanied by elevated CSF IgG index Lee KY. Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Korea – [email protected] Acute cerebellitis, a rare inflammatory syndrome of the cerebellum, is one of the important causes of acute cerebellar dysfunction in childhood. Although it typically presents with cerebellar dysfunction such as ataxia, non-localizing symptoms such as headache can be much more prominent than cerebellar symptoms because of increased intracranial pressure as a result of cerebellar swelling. The cerebrospinal fluid (CSF) IgG index is most often tested clinically in the diagnosis of multiple sclerosis. However, it is not specific to multiple sclerosis, and can be elevated in a variety of neurologic diseases, including bacterial and viral central nervous system infections. A 7-year-old boy with acute cerebellitis presenting with sudden onset headache and only subtle cerebellar dysfunction demonstrated an elevated CSF
Lee YJ, Yeon GM, Nam SO, Kim YM. Department of Pediatrics, Pusan National University Children’s Hospital, Yangsan-si, Korea – [email protected] Purpose: The aim of this study was to compare the effect of the different etiologies in the children with CNS infection on the incidence of initial vs hospital-acquired hyponatremia (IH vs HAH) (plasma sodium concentration, PNa <135 mmol/L). Methods: Children who treated for CNS infection and required the administration of intravenous fluid between 2011 and 2012 were evaluated retrospectively. The children were classified into 4 groups: group A of aseptic meningitis, group B of viral meningoencephalitis, group C of bacterial meningitis, and group D of tuberculous meningitis. All patients had measured the initial PNa and were retested serially. By the sodium concentration of fluid, children were divided into 2 groups: group I of the under 0.45% saline in dextrose, and group II of more than 0.45% saline. Results: We identified 248 children (185 in group A, 33 in group B, 27 in group C, and 3 in group D). The mean age was younger in children of group C (3.5±5.3 years) (p=0.0124) than in those of group A (5.7±3.9 years) or group B (6.3±5.5 years). IH and HAH was found in 13.3% (33/248) and 10.1% (25/248) of all patients, respectively. The incidence of IH was significantly higher in group C (8/27, 29.6%) (p=0.0082) than in group A (17/185, 9.2%) or group B (7/33, 21.2%). HAH was more frequent in group B (9/33, 27.3%) (p=0.0004) and in group D (2/3, 66.7%) (p=0.0011) than in group A (9/185, 4.9%) (p<0.0001) or in group C (5/27, 18.5%) (p=0.1229). Of the patients in group I, 27.6% (8/29) developed more common HAH compared with 7.8% (17/219) in group II (p=0.0009). Any hyponatremia was not noted in 82.2% (180/219) in group II during the period of hospitalization (p<0.0001). Conclusion: Hyponatremia was common in children with CNS infection, and the incidence showed distinct differences among the different etiologies. The administration of more than 0.45% saline could help in reducing the incidence of HAH in children with CNS infection.
P133 - 1513 Clinical application of viral CSF PCR studies: a retrospective 11-year experience Kleines M, Scheithauer S, Schiefer J, Häusler M. Department of Infection Control and Infectious Diseases, University Hospital RWTH Aachen, Germany – [email protected] Background: The PCR is the method of choice to detect viral activity in the central nervous system (CNS). Positive findings, however, do not prove an impact on the neurological problem. Here, knowledge on large patient groups may facilitate data interpretation. Methods: A retrospective analysis of CSF PCR data concerning 514 pediatric and 2904 adult samples, focusing on Epstein-Barr virus (EBV), cytomegalovirus (CMV), herpes simplex virus (HSV), enteroviruses (ENV), human herpesvirus type 6 (HHV-6) and varicella zoster virus (VZV). Results: EBV was detected in 1.63%, VZV in 1.3%, HSV in 0.4%, ENV in 0.4%, CMV in 0.2% and HHV-6 in 0.2% of the patients studied, respectively. Detection rates were higher among very young and among older patients. HSV, VZV and ENV were dominant in typical infectious CNS diseases, EBV in further inflammatory diseases (bacterial CNS infections, multiple sclerosis, HIV infection) and in diseases not typically attributed to infections. HSV and VZV were frequent