NEU/01(P) MULTIPLE CAVERNOMAS PRESENTING AS EPILEPSY
Sheffali Gulati, Lokesh Guglani, Devashish Saini, Ajay Garg
Associate Professor, Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi – 110029.
Seizures may occur in children due to a variety of etiologies, and vascular malformations of the central nervous system are a rare cause of seizures. Most case series show that vascular malformations comprise <1% of children presenting with epilepsy. Vascular developmental malformations of the central nervous system can be broadly classified into four categories –
arteriovenous malformations, cavernous malformations, venous malformations, and telangiectasias. Cavernomas (also known as cavernous malformations, angiomas or hemangiomas), comprise only 8-15% of all vascular malformations, and of all cases with cavernomas, multiple cavernomas are present in only 10% of patients. Onset of symptoms in patients with cavernomas is usually in the third or fourth decade of life and their presentation in early childhood is relatively rare. Hence clinical recognition of these relatively rare vascular malformations in childhood is important as their management totally differs from that of other types of malformations. We report a case of multiple cavernous malformations of the brain in a 9 year old child presenting with epilepsy.
NEU/02(O) RANDOMIZED PLACEBO CONTROLLED TRIAL OF GABAPENTIN IN
CHILDREN WITH SPINAL MUSCULAR ATROPHY
Sheffali Gulati, Sumita Bisoi, Sandeep Singh, Sanjay Wadhwa, Veena kalra
Associate Professor, Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi – 110029.
Introduction: Spinal muscular atrophy is an autosomal recessive disease of varying severity with atrophy and weakness of the voluntary muscles. Its pathogenesis remains speculative. Gabapentin, a drug with possible antiglutamate action has been shown, to prolong the survival of motor neurons. Generally gabapentin is well tolerated. Aims & Objectives: To study the efficacy and
safety of gabapentin in children with spinal muscular atrophy. Materials & Methods: A Randomised Placebo Controlled Trial. Inclusion criteria : All children having motor weakness, hypotonia and hyporeflexia with onset noticed after 6 months of age were screened and those having SMA type II & SMA type III and weighing less than 20 kg were included. Exclusion criteria: SMA type I; onset before 6 months of age; Severely ill and unstable patients requiring life support system; Other causes Patients enrolled were randomized into two groups: Group I (Physiotherapy + Placebos); Group II (Physiotherapy Gabapentin) Patients were clinically +
evaluated at baseline and 12, 24, 36 and 52 weeks by history, examination, a careful muscle charting on a 5 point scale and functional evaluation based on the milestones achieved. The physiotherapist was blinded to group allocation. Patients were observed for adverse effects and compliance ensured for drug and physiotherapy. Results: Forty children were enrolled and followed up for atleast one year. Twenty five were boys and 15 girls with age range from 9-144 months. Wilcoxon-rank-sum (Mann Whitney) test was used to compare baseline and followup parameters. There was no statistically significant improvement in the Gabapentin group as compared to the placebo group either in muscle charting or functional evaluation. None of the children had any significant side effects. Conclusion: Gabapentin did not show any statistically significant improvement in motor function in children with SMA type II or III.
NEU/03(O) MAGNETIC RESONANCE IMAGING OF BRAIN IN PEDIATRIC
PATIENTS WITH PARTIAL SEIZURES
Ashok K. Gupta, Ravi Kumar Parihar, G.S.Saini, Ghanshyamdev.
Prof.& Head Deptt. Of Pediatrics Govt. Medical College, S.M.G.S. Hospital, Jammu(J&K) 180 001
doc_ ashokg @ yahoo.co.in
INTRODUCTION Seziures occur in approximately 10% children. Partial onset seizures begin in localized area of cerebral cortex.and may be simple partial or complex partial. Common causes include inflammatory granulomas, atrophic lesions,birth asphyxia, head trauma and neoplasms. In certain geographic areas including INDIA, neurocysticercosis has emerged as a common cause. .Introduction of MRI has substantially revolutionized the evaluation and management of epilepsy and seizure disorder ; being much more senitive than CT. Since only few studies have been made regarding the MRI findings in children with partial seizures. This prospective study examinens the value of MRI brain to identify the region of cerebral origin, etiology, and medical or surgical management of patients with partial seizures.MATERIAL AND METHODS This study was conducted in patients with partial seizures admitted in PEDIATRICS
DEPARTMENT,GOVT.MEDICAL COLLEGE &S.M.G.S. Hospital Jammu for a period of one
year from Nov. 2005 to Oct. 2006.A Special proforma was designed and the information obtained from the history,clinical examination and investigations(MRI in particular) was noted down.All the children from age 28days to 18 years who presented with partial seizures were included. MRI was performed after obtaining informed consent from the patient or his/her attendants.All the patients were screened for any contraindication to the study. RESULTS: Total 43 patients, males 28 . Maximum patients 21- age group 5-15 years.Youngest patient 45 days, oldest 17 years . 24 patients no risk factor,rest 19 had family history of seizures, perinatal insult, TB contact, fever etc. 12 had simple partial & 31 had complex partial. 29 had righted sided involvement. 39 patients demonstated lesions on MRI. In parietal region 19 ,temporal 6, frontal 2, multiple lesions 12 and in 4 MRI normal.Out of 39 , Tuberculoma in 12, Neurocysticercosis in 24 and one each cerebellitis, Sturge Weber syndrome & porenencephalic cyst. 89.74% lesions showed contrast enhancement on MRI. The site of lesion was faithful to the side of epileptic focus in most of the cases.CONCLUSION: As cncept of epileptogenic focus is supported by the imaging studies, partial seizures as opposed to generalized seizures are associated with structural lesions of the brain. Contrast enhancement MR altered radiological diagnosis in many patients with partial seizures. It helped to diagnose infections like tuberculoma and NCC in various stages of evolution which are endemic in our region and helped to rule out other structural lesions, thus helping in planning modalities of treatment . New advances in MRI such as shaped surface coils, improvement in signal to noise ratio, calculations of T-1 and T-2 relaxation constants, paramagnetic agents and in vivo metabolic studies with MR spectroscopy further promise to enhance the potential utility of MRI in seizures in general and partial seizures in particular.
NEU/04(O) CEREBROSPINAL FLUID POLYMERASE CHAIN REACTION FOR THE
DIAGNOSIS OF TUBERCULAR MENINGITIS IN CHILDREN
V Gupta, AK Chaubey, G Nath, GP Katiyar, BD Bhatia
Department of Pediatrics & Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi – 221005
Objective: The study was undertaken to: (1) evaluate the role of polymerase chain reaction (PCR) in the diagnosis of tubercular meningitis and (2) compare cerebrospinal fluid (CSF) culture for Mycobacterium tuberculosis and acid fast bacilli (AFB) staining with PCR results. Material and
Methods: This prospective study was carried out in the Department of Pediatrics, Institute of Medical Sciences, Varanasi over a period of 15 months. A total of 32 CSF specimens from suspected cases of tubercular meningitis were obtained for PCR, culture and AFB staining. The inclusion criteria were fever, headache, vomiting and/or altered sensorium for more than one week with signs of meningeal irritation. The supporting evidence was (i) abnormal cytochemical findings in CSF (ii) suggestive CT scan findings (basal exudates, hydrocephalus) and (iii) associated extraneural tuberculosis. Results: Out of 32 patients of tubercular meningitis, 24 (75%) were TB-PCR positive. The positivity of PCR was 86.7% in relation to positive tuberculin test while a positive TB-PCR was seen in 64.7% cases with negative tuberculin test. Thus there was no significant relationship between tuberculin test and TB-PCR positivity. Mycobacterium tuberculosis were grown in 5 patients and all were positive for TB_PCR also. However, 70.4% cases with negative CSF culture for AFB were also PCR positive. CSF culture also did not have any significant relationship with PCR positivity. AFB staining was positive in only 3 cases, all of whom were TB-PCR positive. Conclusion: Polymerase chain reaction for tuberculosis had sensitivity of 75% with 100% specificity and positive predictive value. Negative predictive value and accuracy of TB-PCR were 74.5% and 93.7% respectively. Host immune status related tests like tuberculin test had high specificity (100%) but low sensitivity and accuracy. To conclude, TB-PCR in CSF can be used as a “Gold standard” for early diagnosis of tuberculous meningitis.
NEU/05(P) CLINICO-AETIOLOGICAL PROFILE OF SEIZURE IN CHILDREN
T.N. Ghosh, K. Nayak, S. Som, N. Chowdhuri, A.K. Dutta
Department of Pediatrics, Burdwan Medical College and Hospital
Introduction :- Seizure is one of the commonest manifestation of central nervous system disorder. In children seizure affect 4-7% of children. Aims And Objective :-To study the various type of seizure disorder. To determine underlying cause of different type of seizure disorder.Material And Methods :-72 patient of seizure disorder between 1 month to 7 year age who were admitted in pediatrics ward of Burdwan Medical College between Jan-2007 to July-2007 were studied. Patient below 1 month of age, head injury, pseudoseizure, and tetanus were excluded from the study. Detail history and clinical examination were done. Patient were investigated for complete hemogram and malaria parasite, x-ray chest, Mantoux test, Serum Electrolytes, Blood Sugar, CSF studies, EEG, and CT scan / MRI brain as indicated clinically. Classification of seizure done according to I L A E system. Result Analysis :-Among total 72 cases provoked or acute symptomatic seizure was found in 54% (39) cases whereas unprovoked seizure was responsible for 46% (33) cases. Among provoked seizure, febrile seizure was the commonest diagnosis 59% (23) followed by meningoencephalitis 31% (12). In unprovoked seizure cause was undetected in 27% (9) cases,whereas, aetiology was found in 73% (24) cases. Ring enhancing lesion in CT scan brain was responsible for 54% (13) cases and underlying brain disorder was found in 46% (11) cases among symtomatic seizure disorder. In idiopathic group generalized seizure was commonest clinical (77%) type where as in symptomatic group partial (10) seizure was most common type. Conclusion :-Simple febrile seizure is the commonest of seizure in children in our study.Ring enhancing lesion in CT scan brain still one of the major cause of seizure among unprovoked seizure disorder.Generalized seizure is common in febrile seizure and Idiopathic group whereas, partial seizure is more common in symptomatic unprovoked seizure.
NEU/06(P) NEUROCYSTICERCOSIS:CLINICO-RADIOLOGICAL PROFILE IN
CHILDREN ATTENDING PRIVATE MEDICAL COLLEGE
Ravinder K. Gupta
Department of Pediatrics, Acharya Shri Chander College of Medical Sciences (ASCOMS) Sidhra, Jammu.
Objective:To study the clinico-radiological profile of neurocysticercosis in children attending private Medical College. Setting: Outdoor and Indoor wing of Department of Pediatrics ASCOMS Hospital.Design:Prospective StudySubjects and Methods: Fifty children confirmed to have neurocysticercosis (NCC) were considered for the study. All of them were treated. The initial presentation of these children and the correlation with the radiological location in form of CT scan and MRI Brain were analyzed. Relevant investigations were performed to exclude other causes. Each child was given anticonvulsants, albendazole for 4 weeks and short term steroids. These children were followed after 6 months and were asked to have neuroimaging repeated.Results: There was a definite male dominance (M:F = 1.5 :1). Majority of the children (64%) were between the age group of 3-9 years. Initial presentation were simple partial seizures (54%) with [motor (20), sensory (2) symptoms and secondary generalization (5)]. Other types of seizures included complex partial seizures (22%) and generalized tonic clonic seizures (28%). Headache (4%) and visual complaints (2%) were other presenting features. Right parietal (30%), left parietal (24%), right parieto-ocipatal (18%), left temporal (14%) and multiple lesions (14%) were the radiological evidence (CT scan and MRI Brain). Repeat neuro imaging done after 6 months showed complete resolution of the lesions in (76%) cases, regression of lesions (16%) and calcification (8%). There was no recurrence of seizures.Conclusion: Neurocysticercosis has varied presentation. Besides partial seizures, generalized tonic clonic seizures can also be the initial presentation. Parietal lesions are the commonest neuro imaging finding. Albendazole therapy can lead to complete resolution. Neurocysticercosis has a better prognosis.
NEU/07(P) CLINICO-AETIOLOGICAL PROFILE OF SEIZURE IN CHILDREN
N. Chowdhuri, A.K. Dutta, T.N. Ghosh, K. Nayak, S. Som
Department of Pediatrics, Burdwan Medical College and Hospital
Introduction:- Seizure is one of the commonest manifestation of central nervous system disorder. In children seizure affect 4-7% of children. Aims And Objective :-To study the various type of seizure disorder. To determine underlying cause of different type of seizure disorder.Material And Methods :-72 patient of seizure disorder between 1 month to 7 year age who were admitted in pediatrics ward of Burdwan Medical College between Jan-2007 to July-2007 were studied. Patient below 1 month of age, head injury, pseudoseizure, and tetanus were excluded from the study. Detail history and clinical examination were done. Patient were investigated for complete hemogram and malaria parasite, x-ray chest, Mantoux test, Serum Electrolytes, Blood Sugar, CSF studies, EEG, and CT scan / MRI brain as indicated clinically. Classification of seizure done according to I L A E system. Result Analysis :-Among total 72 cases provoked or acute symptomatic seizure was found in 54% (39) cases whereas unprovoked seizure was responsible for 46% (33) cases. Among provoked seizure, febrile seizure was the commonest diagnosis 59% (23) followed by meningoencephalitis 31% (12). In unprovoked seizure cause was undetected in 27% (9) cases,whereas, aetiology was found in 73% (24) cases. Ring enhancing lesion in CT scan brain was responsible for 54% (13) cases and underlying brain disorder was found in 46% (11) cases among symtomatic seizure disorder. In idiopathic group generalized seizure was commonest clinical (77%) type where as in symptomatic group partial (10) seizure was most common type.
Conclusion :-Simple febrile seizure is the commonest of seizure in children in our study.Ring enhancing lesion in CT scan brain still one of the major cause of seizure among unprovoked seizure disorder.Generalized seizure is common in febrile seizure and Idiopathic group whereas, partial seizure is more common in symptomatic unprovoked seizure.
NEU/08(P) A STUDY OF SIGNIFICANCE OF ADENOSINE DEAMINASE (ADA)
LEVELS IN C.S.F AS A BIOCHEMICAL MARKER OF C.N.S INFECTIONS.
NP Chhangani, Pramod Sharma, Anurag Meena
Department of Pediatric Medicine, Umaid Hospital for Women and Children, Dr. S.N. Medical College, Jodhpur.
INTRODUCTION: - Acute infections of the CNS are one of the most common causes of fever with signs and symptoms of neurological dysfunction. There is difficulty in diagnosing meningitis by conventional cytochemical and culture methods as there is an overlap in their results especially in the early course of the disease. Adenosine Deaminase is an enzyme widely distributed in human tissues and has an important physiological role in lymphoid tissues.MATERIAL AND METHODS :- A total of 50 patients of CNS infections were included of whom 17 cases were of tubercular meningitis, 19 patients of pyogenic meningitis and 14 children of aseptic meningitis/viral encephalitis. CSF ADA levels were estimated using the method of Guisti.OBJECTIVES: Evaluate sensitivity, specifity and diagnostic efficacy of CSF ADA levels in differentiating TBM from pyogenic meningitis and aseptic meningitis. Results : CSF ADA levels increased in both cases of pyogenic meningitis and TBM but the increase in the cases of TBM was 5 times that seen in cases of pyogenic meningitis.In cases of acute viral meningitis levels of CSF ADA levels were within the normal range. Increase of ADA in cases of TBM were statistically significant when compared to other groups of meningitis (p<0.01).If a cut off value of 11 units/L was taken the test has a sensitivity of 78% and specificity of 98%.It correlates well with the level of consciousness of the patient and relates exponentially to CSF cytology, CSF protein levels and CSF sugar values CONCLUSION: - Estimation of ADA in CSF is a very simple, cost effective, easy and reliable test and must be included in the battery of routine investigations specially when other means of diagnosis are inconclusive. STATISTICAL METHODS Data analyzed for inter relationship using simple linear and /or curvilinear regression equation and strength of relation between parameters assessed using correlation coefficient.
NEU/09(O) CT LESIONS IN DEVELOPMENTALLY NORMAL CHILDREN WITH
COMPLEX PARTIAL SEIZURES.
Bhuvaneshwari S.R, Renuka, Chandrakala.R, VeenaT.A, Poornima Hedge.
INTRODUCTION: Neurocysticercosis (NC) is an important cause of Complex partial seizures (CPS). AIMS: To identify the intracranial lesions in developmentally normal children with CPS by CT scan. MATERIALS AND METHODS: The details of 66 developmentally normal children with CPS in the age group of 1-18 years, for a period of one year were collected prospectively from a preformed proforma. Children with known neurological or psychiatric diseases and where consent for CT scan was not available were excluded from the study. These children presented either to the emergency ward or referred to the CT scan center of RL Jalappa hospital, underwent both plain and contrast cranial CT scan using SEIMENS Spiral CT scanner. They also had other relevant investigation particularly for tuberculosis and NC as suggested by history and examination. Details were statistically analysed using SPSS 11. Children were managed with anti convulsants and anti tubercular or anti cysticercal therapy as indicated. RESULTS: In 66 children with CPS 53(80.3%) had an abnormal CT scan; of this 51 had NC and 2 had tuberculoma. CT
scan lesions were single ring enhancing in 36(67.9%) cases and multiple calcified granulomas in 17(32.1%). Lesions were located either in parietal lobe (35.84%), frontal lobe (32.1%), temporal lobe (9.43%), and occipital lobe (7.54%) or in other areas (15.09%). The size of the lesion was less than 20mm with regular margins and 91% also had perilesional edema. In 4cases scolex of T.solium was found in the ring enhancing lesions. CONCLUSION: CT scan showed NC as the commonest cause of CPS
NEU/10(P) PREDICTORS OF OUTCOME OF STATUS EPILEPTICUS PRESENTING IN
A TERTIARY CARE CENTRE
Objective: To study the predictors of outcome of Status epilepticus in our institute, at presentation in the ER. Introduction: Status epilepticus is a neurologic emergency associated with significant mortality and morbidity. Early Recognition of Status Epilepticus is of utmost importance because longer the SE, the more difficult the control and more the risk of neurologic sequelae. The present Study was undertaken to recognize the predictors of the outcome of the critical event – At
presentation in ER. Methodology: The study was conducted in ICH & HC during January2007 to April 2007 as a prospective descriptive study. Children aged between 2months to 12 years who presented with Status epilepticus at our emergency department were included in our study. The Clinical details were documented and the children were managed based on the guidelines given by Pediatric Advanced Life Support Manual, American Heart Association 2006. These children were followed up in the wards for their outcome. Results: The total number of children presenting with Status epilepticus was 483, of which 85,2 % recovered, 1.9 % developed new sequelae and the mortality rate was 12.6 %. Mortality was slightly higher amongst females , but was not statistically significant (p : 0.107). Out of these, 92.5% of the children developed seizures while at home. GTCS was the most common type of seizure, but the type of seizure was not co-related with outcome. It was observed that more than three seizure episodes had high mortality (21.2 %) which was statistically significant (p:0.01). Mortality was Higher in children who had Altered level of Consciousness prior to the seizure (35.7%) versus those who did not have it (7.4%). Out of the 61 children who died, 55.7 % did not receive prehospital therapy. Mortality was higher in patients with Developmental delay (15.2%) versus (11.2%) normal children, but was not statistically significant. Mortality was higher in patients who presented with associated shock (15.2% vs 6.2%), but was not statistically significant. 51 out of the 205 children on Drug prophylaxis for seizure reported poor compliance. But, this did not co-relate with mortality. Fever was the trigger event in 289 Patients (59.8 %). Out of the 483 children, 18 had a family history of seizures. The etiology could be attributed to Trauma in 8, Toxin ingestion in 14 and Drug ingestion in 7 cases, none correlating with the outcome. Conclusion: Children who have Altered sensorium and more than three seizure episodes at presentation had poor outcome. Fever being the triggering factor in 59.8% of children, points to the need for aggressive antipyretic therapy.Failure to adhere to anti-seizure prophylaxis management was present in 25%. Hence appropriate counseling must be provided to the parents on the significance of regular drug therapy.
NEU/11(O) PEDIATRIC MORTALITY DUE TO NEUROLOGICAL ILLNESS: A
DECADE’S EXPERIENCE OF A TERTIARY CARE CENTER
Adhikari K M , Mathai S, Kanitkar M.
Department of pediatrics, Armed Forces Medical College, Pune
Background: In our country, neurological illnesses still account for significant amount of both mortality and long-term morbidity. Study of contributors to mortality over a long duration of time would bring out etiological correlates, which could guide interventions. Aim: To determine neurological causes contributing to pediatric mortality over a decade. Methods: This was a retrospective study to determine the mortality due to neurological illness. Data was processed from the hospital records which are kept meticulously at our centre. All the deaths that occurred in pediatric ward from April 1996 to December 2006 were included in the study and neurological illness leading to death was studied in detail. Cases where the diagnosis was purely clinical without laboratory or imaging confirmation were excluded. Results: There were a total of 262 deaths during the period of 10 years. Out of these, 56 deaths were attributable to neurological illness constituting 21% of total deaths. Male children constituted the majority (35 males: 62.5 %, 21 females: 37.5 %). Median age was 04 months and mean age of children who died was 28 months (Range: 15 days to 120 months). Fifty percent (28/56)of mortality was in children aged 12 months or less and 48(85.7%) deaths were in under-five children. Following illnesses constituted for majority of deaths related to neurological cause: Infections of central nervous system 20 (35.7 %), Malignancy 12 ( 21.4%), congenital malformations 9 (16%), Neurodegenerative illness 5(9%) and intracranial bleeding due to AV malformation 4(7 %). When three children with encephalitis who presented in quick succession were excluded, there were only five deaths in children more than 5 years due to neurological illness. There were two cases each of fatal head injury and cerebral palsy with superadded sepsis/pneumonia. One child each succumbed to Guillian –Barre syndrome and status epilepticus. Conclusion: This study highlights that neurological illness are common cause of under five mortality in a tertiary care set up. Even in such centers, infections of CNS and deaths due to congenital malformations constitute for majority of deaths related to neurological illness. After the age of five years, neurological cause for mortality was much lower. Better vaccination strategies, improvement in nutrition and other methods to reduce infections, early identification of CNS infections and peri-conceptional folic acid supplementation would help in substantial reduction of deaths in children due to neurological illness.
NEU/12(P) NEUROIMAGING IN ORGANIC ACIDEMIAS
Rajkumar Agarwal , Mamta Muranjan
Genetic Clinic, Department of Pediatrics, King Edward Memorial Hospital, Parel, Mumbai 400 012.
Objective: To study the type and specificity of abnormalities on CT Scans or MRI in patients with organic acidemias. Setting: Genetic Clinic of a tertiary referral center in Mumbai. Method: Retrospective review of clinical records of patients diagnosed to have organic acidemias on the basis of urine GC-MS and/or blood acylcarnitine profile. Results: Sixty nine cases of organic acidemias were diagnosed over a period of 10 years from January 1995 through December 2004. Neuroimaging was performed in 45 patients: CT scan in 15 patients, MRI in 35 patients and in 5 patients both CT Scan & MRI were obtained. Abnormalities on CT scan were detected in 11 patients. MRI was abnormal in 34 out of 35 patients (97%). One patient diagnosed with propionic academia had a normal MRI. MRI detected basal ganglia abnormalities in two patients
with respiratory chain disorders who had normal CT.Scans. The abnormalities noted on MRI were subcortical white matter abnormalities (12.4%), deep white matter abnormalities (35%), delayed myelination (26.1%), cerebellar involvement (20.3%), cortical grey matter involvement (6%), basal ganglia involvement (52%), generalized atrophy (35%) & enlarged CSF spaces (29%). Characteristic abnormalities were detected on MRI in patients with glutaric acidemia type 1 & two patients with Leigh’s disease. Abnormalities on CT Scan in glutaric acidemia type 1 were enlarged CSF spaces and basal ganglia hypodensity. Abnormalities on MRI were basal ganglia lesions, enlarged CSF spaces, cortical atrophy and white matter abnormalities. CT scan in Leigh’s disease showed cerebral & cerebellar white matter abnormalities while MRI showed white matter involvement, abnormalities of globus pallidus, putamina and brain stem nuclei. CT scan of the patient with Canavan disease revealed symmetric hyodensities within the cerebral white matter as well as globus pallidus, thalami & internal capsule. Conclusion: With the exception of glutaric acidemia type I, Leigh’s disease and Canavan disease neuroimaging feature in other organic acidemias are of no diagnostic significance. Majority of patients however demonstrate abnormalities especially on MRI implying that normal neuroimaging makes presence of an organic acidemia unlikely. Therefore in presence of financial constraints neuroimaging can be deferred in cases suspected to have organic acidemias. However with suspicion of glutaric acidemia type 1, Leigh’s or Canavan disease neuroimaging is an adjunct and provides valuable
clues to the underlying etiology.
NEU/13(O) HOSPITAL BASED STUDY OF RECENT OUTBREAK OF
MENINGOCOCCAL INFECTION IN DELHI AND ADJOINING AREA.
Aggarwal KC, Goel PC, Prasad MS, Salhan RN,Nair D
Department of Pediatrics, Safdarjung Hospital, New Delhi-110029.
Design of Study –Hospital –based prospective cross-sectional clinical study.Study Period –Jan.
2006 to April 200. Material and Methodology- Meningococcal infection is an ubiquitous infection seen over world wide. It is caused by Gram negative intracellular diplococci and has many serotypes e.g. A, B, C, Y and W135.During the January 2006 to April 2007 period , a total of 106 suspected cases (with high grade fever, maculopapular to petechial rash, with or without shock and with or without neck stffness and bulging anterior fontanelle) were admitted in pediatrics ward. After clinical examination patients were subjected to extensive hematological and microbiological investigations like complete hemogram, blood culture. CSF examination for Gram’s staining ,cytology and biochemistry and culture. Blood and CSF latex agglutination test (LAT) was also done as quick diagnostic test. Contact survey by throat culture was not done because of poor unpredictability described in literature. All the patients were appropriately managed by I/V injection Ceftriaxone, intravenous fluid ,pressor support, and oxygen and steroid where ever indicated pending culture report. Antibiotics revision was considered depending upon response and culture sensitivity report. All the confirmed cases were categorized as per age,weight and type of manifestation. Contacts of confirmed cases were also administered rifampicin or ciprofloxacin depending upon age(infants were givenrifampin). Monthwise collection of cases was also tabulated. Results- out of a total 106 cases only 65 were confirmed cases and further analysed. All the cases belonged to either Delhi or the adjoining Delhi region. Male to Female ratio was 30:35 ie 6:7. Age wise distribution was also as follows. I month - 2/65(3.07%) 1month upto 1year- 7/65(10.77%) 1year upto 3years - 5/65(7.69%) 3 year upto 6 years 9/65(13.85%) 6 year upto 9 years -20/65(30.77%) > 9 years - 22/65(33.85%) 25 cases(38.46%) had only Meningococcemia (only blood positive),24(36.92%) cases had both meningitis and meningococcemia and 16 cases(24.61%) had had meningitis only. Only 3 cases presented with shock. 62/65 cases(95.3%). had rash. All the cases were confirmed by blood or CSF latex agglutination test or culture. Only 2 rdchildren grew Group A serotype sensitive to 3 generation Cephalosporins. 2 newborns were also
diagnosed. Unusaul manifestation included joint swelling in 4, generalized swelling in 2, iridocyclitis in 1, acute renal failure(ARF) in 2, hemiparesis in 1, paraparesis in 1 and superficial gangrene in 6. Mortality was in 24/65(24.6%) .All the cases died within 24 hours of admission. Discussion and conclusion- 1. in our study only in 2 cases, blood culture grew type A meningococcus which could be attributed to prior administration of antibiotics before hospitalization. 2. 2 cases had positive group A poistivity coformig to observation of other studies of type of serotype isolated in Asiatic region. No case of serotype B grown which is a common isolate in west. 3. 2 newborns were also afflicted and diagnosed in our study contrary to earlier study where less than 3 month age group is sparingly affected. In these cases even linkages to mother was also confirmed. 4. other uncommon manifestation like renal failure and stroke were also seen in some cases. 5 mortality was 24.6% in our study which is also acceptable depending upon severity(15-30% reported in literature as per severity). And also partly late reporting to hospital. 6. main clustering of cases occurred around april to june unlike western literature. 7. mortality was mainly seen in newborns and those presented with both meningococcemia and meningitis.
NEU/14(P) SERUM LIPID LEVELS AND LIVER FUNCTION TESTS IN CHILDREN ON
PHENYTOIN OR VALPROATE THERAPY.
Anju Aggarwal, Pooja Dewan, M.M.A Faridi.
University College of Medical Sciences and Guru Tegh Bahadur Hospital, New Delhi. firstname.lastname@example.org
Introduction: Serum lipids and liver function tests ( LFT’s) are altered in children on antiepileptic drugs, due to induction of liver enzymes. Aims : To study serum lipids and LFT’s in children aged
2-12 years receiving phenytoin or valproate therapy. Study Design – Prospective case control
study. Method – A total of 79 children (44 males, 35 females) were included (27 in valproate, 25 in phenytoin and 27 in control group). Children in valproate and phenytoin group were on antiepileptic therapy for at least six months. Sample was collected after an informed consent when the child was fasting for at least 12 hours. Serum lipids and LFT’s were determined as per standard procedure. Results. Mean age was 7.46 ?3.44 years. There was no difference in mean weight and BMI in the three groups . Mean total cholesterol (TC) was 133.15 ? 31.67 mg/dl, 146.72 ? 18.55 mg/dl and 126.26 ? 30.14 mg/dl in the valproate, phenytoin and control group respectively. TC in the phenytoin group was significantly higher than controls(P=0.03). HDL, VLDL, HDL, triglycerides and HDL/LDL ratio were not significantly different in the three groups (P>0.05). Serum alkaline phosphate was significantly higher in the phenytoin group (P=0.03). Proportion of children with TC >200mg/dl was significantly higher in the phenytoin group. Conclusions: Serum lipids are altered in children on phenytoin therapy. Hence lipid levels of children on phenytoin therapy should be monitored and long-term effect of alteration in lipids needs to be evaluated.
NEU/15(P) OCULAR EXAMINATION: A WINDOW TO NEUROLOGICAL DIAGNOSIS
Surekha Joshi, Ehtesham Kazmi, Sushma Malik, Sushma Save.
Govt Qtrs, Bld no 1, Flat no 25, Haji Ali,Mahalaxmi, Mumbai-400034
Introduction-Evaluation of a child with a neurological disorder involves a detailed CNS examination of which an integral and important component is the eye examination. A thorough examination of eye often clinches the diagnosis and also offers an important etiological clue. Aims & Objectives-We studied the incidence, spectrum and correlation of ocular findings in neurological disorders in children. Material & Methods-This was a prospective observational study involving 60 children with neurological disorders over a study period of nine months. All
the subjects underwent detailed systemic & CNS examination in addition to thorough eye examination. The latter included testing for visual acuity & cranial nerves, fundoscopy and slit lamp examination. Further investigations were done as considered appropriate. Results- Amongst 60 study cases ,we had 29 males and 31 females and majority of cases (83%) were above one year and there were 17% infants. Only 20% of patients primarily presented with ocular complaints whereas the rest had non-ocular complaints like fever, convulsions, delayed milestones, altered sensorium and raised ICT. Ocular complaints included visual impairment, squint, ptosis, nystagmus & difficulty in closing eyes. Anatomical distribution of ocular findings involved the eyelid, globe, fundus (retina, optic nerve, choriod) iris and cornea. The spectrum of fundal changes (42%) seen were optic atrophy (28%), papilledema (20%), cherry red spots, chorioretinitis, choriod tubercles and coloboma. External ophthalmoplegia, KF ring, cataract and corneal opacity were the other ocular findings observed. Our study also revealed that the majority of the CNS disorders were infective ( TBM,viral encephalitis, IU infection etc) in origin (38%),followed by cerebral palsy (27%),syndromes (17%), neurodegenerative and Wilson’s disease. Conclusions-
Eye examination is vital to clinch the underlying CNS disorder. It also helps in evaluating therapy, detecting complications and prognosticating the patients.
NEU/16(P) RECURRENT BACTERIAL MENINGITIS DUE TO INTRACRANIAL
Dilip Kumar, Ravinder Kumar, Sumaira Khalil, Anju Aggarwal.
Department of Pediatrics University College of Medical Sciences and Guru Tegh Bahadur Hospital, Delhi – 95.
Introduction: Recurrent bacterial meningitis is rare. It requires a careful evaluation for either an anatomical defect or immunological deficit, or combination of two. Immunological problems are suggested by recurrent episodes of infection at multiple sites. Case report: A 5? yrs old male child presented with fever moderate to high grade, headache, neck pain, photophobia, vomiting. He was hospitalized 6 months back for similar complaints, was diagnosed and treated as meningitis. There was no history of infection at multiple sites. Child was of average build and nutrition .On examination signs of meningeal irritation were present. There was no neurological deficit. Lumbar puncture revealed turbid CSF and raised proteins. Culture did not reveal any organism. MRI brain revealed large well defined midline cystic lesion 31 x 26x 28 mm in size in suprasellar region suggestive of arachnoid cyst. Child responded well to ceftraixone and vancomycin and was discharged after 10 days of therapy. Conclusion: Neuroimaging is essential in any patient presenting with recurrent meningitis. Arachnoid cysts are rare, representing <1% of all intracranial space occupying lesion, and their association with recurrent meningitis rarer still. Hence the rarity of our case. They are known to cause recurrent meningitis if there is an external communication which allows bacterial entry. Cisternography is also required to evaluate for external communication of the cyst.