Neuroimaging Spectrum of Severe Hypernatremia in Infants with Neurological Manifestations

2021 ◽  
Author(s):  
Arushi Gahlot Saini ◽  
Sameer Vyas ◽  
Amrit Kaur ◽  
Prabhjyot Singh ◽  
Muralidharan Jayashree ◽  
...  
Keyword(s):  
White Matter ◽  
Venous Thrombosis ◽  
Clinical Features ◽  
Tertiary Care ◽  
Background Variable ◽  
Care Hospital ◽  
Neurological Manifestations ◽  
White Matter Changes ◽  
Neurological Sequelae ◽  
Osmotic Demyelination

Abstract Background Variable neurological manifestations and imaging findings have been described in children with severe hypernatremia. We aimed to describe the spectrum of neuroimaging changes in infants with severe hypernatremia. Methods This retrospective study included infants with severe hypernatremia (serum sodium >160 mEq/L), abnormal neurological examination, and an abnormal magnetic resonance imaging (MRI) of the brain over a period of 2 years in a tertiary care hospital. Relevant clinical data, including the feeding practices, clinical features, complications, and biochemical and radiological parameters, were entered in a structured pro forma. MRI findings were classified as vascular (hemorrhages and cerebral sinus venous thrombosis), osmotic demyelination syndrome (pontine and extrapontine myelinolyses), and white matter changes. Results The common clinical features in the neonates were poor feeding (n = 4) and decreased urine output (n = 4); the older infants presented with gastrointestinal losses (n = 5). All cases had dehydration with encephalopathy. The patterns of radiological injury were vascular (hemorrhages, n = 5 and venous thrombosis, n = 3), osmotic demyelination (n = 8), and white matter changes (n = 7). Coagulopathy was correlated with the vascular complications (r = 0.8, p < 0.0001); the degree of dehydration was correlated with the venous thrombosis (r = 0.7, p < 0.04) and acute kidney injury (r = 0.8, p < 0.001). Neurological sequelae were seen in four cases and correlated with hypernatremia (r = 0.6, p = 0.03) and hyperosmolarity (r = 0.6, p = 0.03). Conclusion Characteristic neuroimaging findings are vascular changes in the form of venous thrombosis and hemorrhages, osmotic demyelination and white matter tract injury, and/or mostly combinations of these findings. Severe hypernatremia and resulting hyperosmolarity frequently cause neurological sequelae in neonates and infants.

scholarly journals Neurological Manifestations of Congenital Cytomegalovirus Infection at a Tertiary Care Centre from Southern India

2021 ◽  
Vol 12 (01) ◽  
pp. 133-136
Author(s):  
Vykuntaraju K. Gowda ◽  
Preeti Kulhalli ◽  
Dhananjaya K. Vamyanmane
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Developmental Delay ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cerebral Atrophy ◽  
Southern India ◽  
Care Hospital ◽  
Neurological Manifestations ◽  
Congenital Cmv

Abstract Background Cytomegalovirus (CMV) is a ubiquitous herpes virus. It is the most common congenital viral infection. Data on congenital CMV in India are lacking and hence the present study was undertaken. Objectives The aim of the study is to evaluate the clinical and radiological profile of neurological manifestations of congenital CMV infections in tertiary care hospital. Methods This is a retrospective chart review of the clinical and laboratory profile of congenital CMV infections presenting from January 2018 to February 2020 to a tertiary care hospital in Southern India. Details of clinical profile, serological and neuroimaging data were obtained and analyzed. Results A total of 42 cases with female preponderance (57%) were reported during the study period. The mean age of presentation was 2.9 years. Clinical features were developmental delay (81%), microcephaly (93%), seizures (33%), intrauterine growth restriction (19%), neonatal encephalopathy (10%), anemia (9%), jaundice (10%), hepato-splenomegaly (7%), and eye abnormalities (14%). Antenatal maternal fever was reported by 12%. Sensorineural hearing loss was present in 57%. Neuroimaging showed periventricular calcification (79%), cerebral atrophy (69%), ventricular dilatation (55%), malformations (26%), dysmyelination (12%), and temporal lobe cysts (5%). CMV-immunoglobulin-M positivity was seen in 14 cases (33%), urinary polymerase chain reaction for CMV was positive in 21 cases (50%), and clinical diagnosis was done in seven cases (16%). Conclusion Common findings in congenital CMV are microcephaly, developmental delay, seizures, anemia, and sensorineural hearing loss. Common neuroimaging findings are periventricular calcification, cerebral atrophy, malformation, white matter signal changes, and cysts. CMV can mimic like cerebral palsy, malformations of the brain, demyelinating disorders, and calcified leukoencephalopathies like Aicardi-Goutières syndrome.

scholarly journals Clinical Presentation of Preterm Neonates with Intraventricular Hemorrhage: Experience in a Tertiary Care Hospital in Dhaka

2017 ◽  
Vol 7 (3) ◽  
pp. 194-197
Author(s):  
Tasnima Ahmed ◽  
Abdul Baki ◽  
Tahmina Begum ◽  
Nazmun Nahar
Keyword(s):  
Clinical Features ◽  
Intraventricular Hemorrhage ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Sudden Onset ◽  
Morbidity And Mortality ◽  
Preterm Neonates ◽  
Cranial Ultrasound ◽  
Care Hospital ◽  
One Year

Background: Intraventricular hemorrhage (IVH) is common among preterm infants as many of them survive with the advancements in neonatal care. Severe IVH may lead to significant morbidity and mortality. The objective of our study is to find out the significant clinical signs of IVH in preterm neonate for early detection by ultrasonography.Methods: This prospective observational study was done in special care baby unit (SCABU), Bangladesh Institute of Research & rehabilitation of Diabetic, Endocrine & metabolic Disorder (BIRDEM) for a period of one year. Eighty five preterm neonates were included in this study. Clinical features of IVH like- convulsion, lethargy, irritability, bulged fontanelle, recurrent apnea, sudden onset of respiratory distress, sudden pallor and bradycardia were observed. Cranial ultrasound studies were done within 7 days of life in all cases to identify IVH.Result: Mean gestational age of these neonates was 31.31(±2.2) weeks & mean birth weight was 1413.42 (±330.55) gm. Among 85 preterm neonates 21(24.7%) developed IVH, confirmed by ultrasonography of brain. Clinical features like convulsion, bulged fontanel, repeated apnea & sudden pallor were significantly present in IVH group.Conclusion: Intraventricular Hemorrhage constitutes an important cause of morbidity and mortality in neonate. This study showed that clinical features like convulsion, bulged fontanel and sudden pallor had a significant relationship with intraventricular hemorrhage which will help for its early detection.Birdem Med J 2017; 7(3): 194-197

scholarly journals Cerebral Venous Thrombosis Case Series at a Tertiary Care Hospital: Exploring Treatment Safety and Efficacy of Direct Oral Anticoagulants

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3658-3658
Author(s):  
Mohammed Abdullah Alsheef ◽  
Mukhtar Alomar ◽  
Abdul Rehman Z. Zaidi ◽  
Ghaydaa Juma Kullab ◽  
Mohammed AlHazzaa ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Tertiary Care ◽  
Case Series ◽  
Case Report Form ◽  
Care Hospital ◽  
Safety And Efficacy ◽  
Number Of Patients

Background: Cerebral venous thrombosis (CVT) is an uncommon cause of stroke that mainly affects young adults and children. Initial treatment with heparin followed by wafarin is the mainstay of treatment. Only insufficient experience is available for direct oral anticoagulants (DOACs). Aims: The study aims to demonstrate the efficacy and safety of DOACs such as (Rivaroxaban and Dabigatran) in patients with objectively confirmed CVT. Methods: Data of 46 cases of CVT collected using a standardized case report form. Inclusion criteria were patients diagnosed with CVT, confirmed by CT or MRI imaging. Results: The total number of patients was 46 (9 males and 37 females). The mean age of the patients was 35.2± 5 years. The most common clinical manifestations among our patients were headache followed by seizure. 52% of cases were unprovoked, while 48% were provoked by pregnancy and oral contraceptive pills. Superior sagittal sinus (55%) and transverse sinus (44.9%) were the most common sites. Involvement of more than three venous sinuses was 34.8%. Thrombophilic abnormality was detected in 21.7% of patients. Initiation of anticoagulation (AC) was mostly low molecular weight heparin (LMWH) (80%), followed by unfractionated heparin (UFH) (17.7%) and fondaparinex (2%). Maintenance AC with Rivaroxaban after heparin (LMWH/UFH) was in 63% of our patients, the rest were switched from Warfarin to Rivaroxaban (34.8%), and one was treated by Dabigatran (2%). CVT recurrence was observed in one patient. Major bleeding (according to ISTH criteria) was not reported in our case series. Conclusions: DOACs demonstrated good safety and efficacy profile and can potentially replace warfarin in CVT patients. Disclosures No relevant conflicts of interest to declare.

scholarly journals Risk factors, clinico-epidemiological profile of tuberculosis among children attending a tertiary care hospital: a two year study

2018 ◽  
Vol 5 (3) ◽  
pp. 851
Author(s):  
Ravikumar Tenali ◽  
Naveen Kumar Badri ◽  
Jithendra Kandati ◽  
Munilakshmi Ponugoti
Keyword(s):  
Risk Factors ◽  
Clinical Features ◽  
Tertiary Care ◽  
Epidemiological Surveillance ◽  
P Value ◽  
Tuberculous Lymphadenitis ◽  
Care Hospital ◽  
Female Ratio ◽  
Extra Pulmonary ◽  
Epidemiological Profile

Background: TB remains as the one among the top 10 causes of death worldwide. In 2016, 10.4 million people fell ill with TB, and 1.7 million died from the disease with 0.4 million with HIV. At least 1 million children become ill with TB each year. Children represent about 10-11% of all TB cases. Having knowledge of the risk factors for tuberculosis infection in children is important to evaluate the level of ongoing transmission of infection and to help adapt activities within national TB control programs. The main objective is to study the risk factors and their association and variable clinical features in cases of pulmonary and extra pulmonary tuberculosis.Methods: The main objective is to study the risk factors and their association and variable clinical features in cases of pulmonary and extra pulmonary tuberculosis.Results: 98 cases of TB were confirmed out of total 628 with a prevalence of 17.07% in the   study with 78 PTB cases and 20 EPTB. Females were more with male to female ratio of 0.7:1.5-9 years was the most common age group in the study. Statistically significant association was found between old history of ATT, HIV positivity, contact with an open case of TB and malnutrition (p value<0.05). TB meningitis was the most common EPTB (10/20 cases) followed by tuberculous lymphadenitis (5/20). 69.39% (68/98 cases) were smear positive, radiologically 59.18% of cases were positive and Tuberculin skin test was positive in 46.94%.Conclusions: Childhood tuberculosis is a neglected entity in developing countries due to underreporting and difficulties in diagnosis due to variable clinical picture in children. Hence epidemiological surveillance studies in children are required to determine the actual prevalence of pulmonary and extra pulmonary cases of tuberculosis. Increased efforts are required to isolate TB bacilli from body fluids to identify early the childhood cases and manage them to prevent disease burden in the community.

scholarly journals Characteristics and clinical features of children presenting with acute myocarditis at a tertiary care hospital.

2021 ◽  
Vol 28 (12) ◽  
pp. 1701-1704
Author(s):  
Farhan Zahoor ◽  
Bushra Madni ◽  
Muhammad Imran ◽  
Muhammad Naveed ◽  
Fazal ur Rehman ◽  
...  
Keyword(s):  
Clinical Features ◽  
Rural Areas ◽  
Tertiary Care Hospital ◽  
Acute Myocarditis ◽  
Tertiary Care ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Clinical Feature ◽  
Care Hospital ◽  
Male Predominance

Objective: To find out characteristics and clinical features of children presenting with acute myocarditis at a tertiary care hospital. Study Design: Observational Study. Setting: Department of Pediatrics, Sughra Shafi Medical Complex, Sahara Medical College, Narowal, Pakistan. Period: February 2020 to February 2021. Material & Methods: A total of 71 children aged 1 month to 15 years admitted with acute myocarditis were enrolled. Acute myocarditis was labeled as short history of illness in otherwise healthy child, echocardiography evident of left ventricular dysfunctioning, cardiac biomarkers showing cardiac damage as well as electrocardiography showing acute myocarditis. Age was represented as mean and standard deviation whereas qualitative variables like gender, area of residence and clinical features were shown as frequency and percentages. Results: Out of a total of 71 children, there were 38 (53.5%) were male. Median age was recorded to be 16.6 months. Majority of the cases, 42 (59.2%) belonged to rural areas of residence. Tachycardia was the commonest clinical feature noted in 65 (91.5%) children, irritability was seen in 50 (70.4%), tachypnea in 48 (67.6%) while poor feeding was noted 44 (62.0%) children. Hepatomegaly was noted in 39 (54.9%) children. Hypotension was recorded in 35 (49.3%) children. Conclusion: Male predominance was seen among children presenting with acute myocarditis. Tachycardia, irritability, tachypnea and poor feeding were the commonest clinical features observed.

scholarly journals Magnetic resonance imaging in the diagnosis of white matter signal abnormalities

2018 ◽  
Vol 31 (4) ◽  
pp. 362-371 ◽  
Author(s):  
Ravi Datar ◽  
Asuri Narayan Prasad ◽  
Keng Yeow Tay ◽  
Charles Anthony Rupar ◽  
Pavlo Ohorodnyk ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
White Matter ◽  
Magnetic Resonance ◽  
Tertiary Care ◽  
Diagnostic Utility ◽  
Care Hospital ◽  
Resonance Imaging ◽  
Clinical Tool ◽  
Diagnostic Challenge ◽  
Mri Scans

Background White matter abnormalities (WMAs) pose a diagnostic challenge when trying to establish etiologic diagnoses. During childhood and adult years, genetic disorders, metabolic disorders and acquired conditions are included in differential diagnoses. To assist clinicians and radiologists, a structured algorithm using cranial magnetic resonance imaging (MRI) has been recommended to aid in establishing working diagnoses that facilitate appropriate biochemical and genetic investigations. This retrospective pilot study investigated the validity and diagnostic utility of this algorithm when applied to white matter signal abnormalities (WMSAs) reported on imaging studies of patients seen in our clinics. Methods The MRI algorithm was applied to 31 patients selected from patients attending the neurometabolic/neurogenetic/metabolic/neurology clinics at a tertiary care hospital. These patients varied in age from 5 months to 79 years old, and were reported to have WMSAs on cranial MRI scans. Twenty-one patients had confirmed WMA diagnoses and 10 patients had non-specific WMA diagnoses (etiology unknown). Two radiologists, blinded to confirmed diagnoses, used clinical abstracts and the WMSAs present on patient MRI scans to classify possible WMA diagnoses utilizing the algorithm. Results The MRI algorithm displayed a sensitivity of 100%, a specificity of 30.0% and a positive predicted value of 74.1%. Cohen’s kappa statistic for inter-radiologist agreement was 0.733, suggesting “good” agreement between radiologists. Conclusions Although a high diagnostic utility was not observed, results suggest that this MRI algorithm has promise as a clinical tool for clinicians and radiologists. We discuss the benefits and limitations of this approach.

scholarly journals Clinical Features, Outcomes, and Risk Factors of Bloodstream Infections due to Stenotrophomonas maltophilia in a Tertiary-Care Hospital of China: A Retrospective Analysis

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Yibing Chen ◽  
Jijiang Suo ◽  
Mingmei Du ◽  
Liangan Chen ◽  
Yunxi Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Drug Resistance ◽  
Clinical Features ◽  
Stenotrophomonas Maltophilia ◽  
Pathogenic Bacteria ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
T Tube

Background. Stenotrophomonas maltophilia bacteremia (SMB) is the most perilous situation as compared to other types of S. maltophilia infection. The present study aimed to investigate the clinical features, distribution, drug resistance, and predictors of survival of SMB in a tertiary-care hospital of China. Methods. SMB that occurred in a tertiary-care hospital in Beijing, China, within 9 years (2010–2018) was investigated in a retrospective study. Demographics, incidence, commodities, drug resistance, mortality, as well as antibiotics administration were summarized according to the electronic medical records. The risk factors for survival were analyzed by Chi-square test, Kaplan–Meier curve and Cox regression. Results. A total of 76 episodes of SMB were analyzed. The overall incidence of SMB fluctuated from 3.4 to 15.4 episodes per 1000 admissions over 9 years. Malignancy was the most common comorbidity. High in vitro sensitivity was observed to minocycline (96.1%), levofloxacin (81.6%), and trimethoprim-sulfamethoxazole (89.5%). Central venous catheter (CVC) (p=0.004), mechanical ventilation (MV) (p=0.006), hemodialysis (p=0.024), and septic shock (p=0.016) were significantly different between survival and death group. The 30-day mortality was 34.2% within 30 days after confirmation of blood culture. Factors such as hemodialysis (OR 0.287, 95% CI: 0.084–0.977, p=0.046), T-tube (OR 0.160, 95% CI: 0.029–0.881, p=0.035), and septic shock (OR 0.234, 95% CI: 0.076–0.719, p=0.011) were associated with survival. Conclusions. S. maltophilia is the major nosocomial blood stream infectious pathogenic bacteria. Trimethoprim-sulfamethoxazole and minocycline are optimal antibiotics for the treatment of SMB. T-tube, hemodialysis, and septic shock were the risk factors associated with survival of SMB patients.

scholarly journals Acute Febrile Encephalopathy in Children: A Prospective Study of Clinical Features, Etiology, Mortality, and Risk Factors from Western India

2018 ◽  
Vol 09 (01) ◽  
pp. 019-025 ◽  
Author(s):  
Kirti Gupta ◽  
Charul S. Purani ◽  
Anirban Mandal ◽  
Amitabh Singh
Keyword(s):  
Risk Factors ◽  
Respiratory Failure ◽  
Clinical Features ◽  
High Mortality ◽  
Tertiary Care ◽  
Primary Objective ◽  
Medical Emergency ◽  
Western India ◽  
Care Hospital ◽  
Factors Associated

ABSTRACT Introduction: Acute febrile encephalopathy (AFE) in children is a medical emergency and could be a manifestation of many systemic and central nervous system pathologies. The clinical features of AFE are nonspecific and etiological spectrum variable depending on the studied population. Materials and Methods: A prospective, observational study was carried out including children aged between 1 month and 12 years with AFE admitted to the Pediatric Intensive Care Unit of a tertiary care hospital in Western India. The primary objective was to assess the clinical presentation and etiology of AFE while the secondary objectives were to correlate the clinical and etiological findings and to determine the risk factors associated with mortality. Results: Out of the ninety children with AFE included in this study, male:female ratio was 1.2:1; most of them were aged between 1 and 5 years and came with a history of <7 days (82.2%). All of them had altered sensorium, about 2/3rd had seizures and 47.8% having a Glasgow Coma Score (GCS) <8. Etiology remained elusive in about 40% of the cases, and viral infections were the most common among the ones with an identifiable cause. A variety of morbidity (shock, disseminated intravascular coagulopathy, respiratory failure, etc.) and high mortality (40%) was observed with risk factors associated with mortality being GCS <8, the presence of raised intracranial pressure, shock, and respiratory failure. Conclusion: AFE, though a rare diagnosis in children, is associated with significant morbidity and high mortality in a developing country like India.

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