Ophthalmologic Emergencies

2020 ◽  
pp. 457-478
Author(s):  
Kate Kaufman
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Blunt Trauma ◽  
Pediatric Patients ◽  
Systemic Treatment ◽  
Chemical Exposure ◽  
Eye Injuries ◽  
Eye Size ◽  
Atypical Presentations ◽  
Neonatal Conjunctivitis

Despite sharing similar eye size and anatomy with adults, pediatric patients have unique patterns of ophthalmic infection and injury. Children, especially neonates, have a significantly less developed resistance to the systemic and central nervous system complications associated with ophthalmic infections and trauma. This chapter reviews pediatric eye conditions with a focus on practical approaches for diagnosis and treatment. Special considerations for neonatal conjunctivitis and dacryocystitis are addressed including indications for systemic treatment and criteria for admission. Guidelines are given for the treatment of household chemical exposure and for eye injuries from foreign bodies or blunt trauma. Common and atypical presentations are discussed. Treatment and selected procedures are detailed.

scholarly journals PATH-27. MUTATION DETECTION USING PLASMA CELL-FREE DNA IN CHILDREN WITH CENTRAL NERVOUS SYSTEM TUMORS

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii430-iii430
Author(s):  
Ross Mangum ◽  
Jacquelyn Reuther ◽  
Koel Sen Baksi ◽  
Ryan C Zabriskie ◽  
Ilavarasi Gandhi ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Plasma Cell ◽  
Pediatric Patients ◽  
Cns Tumors ◽  
Cell Free Dna ◽  
Pilot Studies ◽  
Dna And Rna ◽  
Free Dna ◽  
Initial Cohort

Abstract BACKGROUND The role of plasma cell-free DNA (cfDNA) as a cancer biomarker for tracking treatment response and detecting early relapse has been well described for solid tumors outside the central nervous system (CNS). However, the presence of a blood-brain barrier complicates the application of plasma cfDNA analysis for patients with CNS malignancies. METHODS cfDNA was extracted from plasma of pediatric patients with CNS tumors utilizing a QIAmp® MinElute® kit and quantitated with Qubit 2.0 Fluorometer. Extensive genomic testing, including targeted DNA and RNA solid tumor panels, exome and transcriptome sequencing, as well as copy number array, was performed on matched tumor samples as part of the Texas KidsCanSeq study. An Archer® Reveal ctDNA28 NGS kit was then used for assaying the sensitivity of detecting tumor-specific mutations in the plasma of these patients. RESULTS A median of 10.7ng cfDNA/mL plasma (Interquartile range: 6.4 – 15.3) was extracted from 78 patients at time of study enrollment. Longitudinal samples from 24 patients exhibited a median yield of 7.7ng cfDNA/mL plasma (IQR: 5.9 – 9.1). An initial cohort of 6 patients was identified with 7 somatic variants covered by the Archer® Reveal kit. Four of seven mutations identified in matched tumor specimens were detected in patient plasma at variant allele frequencies ranging from 0.2–1%. CONCLUSIONS While challenging, detection of cfDNA in the plasma of pediatric patients with CNS tumors is possible and is being explored in a larger patient cohort along with pilot studies investigating cerebrospinal fluid as an additional source for tumor-specific cfDNA.

scholarly journals LINC-39. PERFORMANCE STATUS OF PEDIATRIC PATIENTS WITH CENTRAL NERVOUS SYSTEM TUMORS TREATED IN MEXICO, A SINGLE-CENTER EXPERIENCE

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii385-iii386
Author(s):  
Claudia Madrigal-Avila ◽  
Alfonso Perez-Bañuelos ◽  
Rafael Ruvalcaba-Sanchez ◽  
Lourdes Vega-Vega ◽  
Gabriela Escamilla-Asiain
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Multidisciplinary Approach ◽  
Pediatric Patients ◽  
Performance Status ◽  
Retrospective Chart Review ◽  
Cns Tumors ◽  
Surgical Morbidity ◽  
Tertiary Center

Abstract BACKGROUND Central nervous system (CNS) tumors are the most common solid neoplasms in the pediatric age, they comprise about a quarter of all cancers at this age. Little is known about the specific epidemiology of this group in Mexico and there are no reports of results focused on the Performance Status of patients who are treated in a multidisciplinary setting. OBJECTIVE To describe the Performance Status of CNS pediatric patients after being treated with a multidisciplinary approach in a tertiary center. METHODS We report a retrospective chart review of all pediatric patients who presented to the Neuro-Oncology Clinic at Teleton Pediatric Oncology Hospital in Queretaro, Mexico, from December 2014 to January 2020. We analyzed age, gender, the extent of surgical resection and histopathology. Performance Status was assessed using ECOG and Karnofsky/Lansky scores during every patient’s last follow-up visit. RESULTS A total of 56 patients were treated, epidemiology and histopathology variants are similar to those described in the international literature. With a median follow-up of 33 months, 35 patients are alive (62.5%), 28 of them (74.2%) have an excellent Performance Status (ECOG score 0 or Lansky/Karnofsky ≥ 90), 5 (14.2%) scored ECOG 1–2 and only 4 (11.4%) scored ECOG 3–4. CONCLUSIONS A multidisciplinary approach with a focus on Performance Status and the potential for neurological recovery is essential in the management of pediatric patients with CNS tumors. Efforts should be aimed at reducing post-surgical morbidity and early rehabilitation to reintegrate patients into society in the long term.

CHRONIC LEAD ENCEPHALOPATHY

PEDIATRICS ◽  
1960 ◽  
Vol 25 (2) ◽  
pp. 309-315
Author(s):  
Harry H. White ◽  
Fred D. Fowler
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Pediatric Patients ◽  
Early Recognition ◽  
Central Nervous System Involvement ◽  
Fast Screening ◽  
The Central Nervous System ◽  
Lead Encephalopathy ◽  
Urinary Coproporphyrin

Chronic lead encephalopathy must be considered in the differential diagnosis of pediatric patients who present with manifestations of schizophrenia, behavior disorders or degenerative diseases of the central nervous system. Determination of urinary coproporphyrin is a simple, fast screening procedure applicable to office practice. The prognosis for normal mental development following encephalopathy is poor. It is hoped that early recognition of the more subtle signs of central nervous system involvement will allow treatment to be instituted soon enough to prevent the crippling mental deterioration which is so often a sequela of lead poisoning.

scholarly journals BRAF V600E Detection in Liquid Biopsies from Pediatric Central Nervous System Tumors

Cancers ◽  
2019 ◽  
Vol 12 (1) ◽  
pp. 66 ◽  
Author(s):  
Noemi García-Romero ◽  
Josefa Carrión-Navarro ◽  
Pilar Areal-Hidalgo ◽  
Ana Ortiz de Mendivil ◽  
Adriá Asensi-Puig ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Genetic Information ◽  
Pediatric Patients ◽  
Digital Pcr ◽  
Braf V600e ◽  
Liquid Biopsies ◽  
Marker Detection ◽  
Minimally Invasive Methods ◽  
Cancer Diseases

Pediatric Central Nervous System (CNS) tumors are the most fatal cancer diseases in childhood. Due to their localization and infiltrative nature, some tumor resections or biopsies are not feasible. In those cases, the use of minimally invasive methods as diagnostic, molecular marker detection, prognostic or monitoring therapies are emerging. The analysis of liquid biopsies which contain genetic information from the tumor has been much more widely explored in adults than in children. We compare the detection of BRAF V600E targetable mutation by digital-PCR from cell-free-DNA and EV-derived DNA (ctDNA) in serum, plasma and cerebrospinal fluid (CSF) isolated from a cohort of 29 CNS pediatric patients. Here we demonstrate that ctDNA isolated from serum and plasma could be successfully analyzed to obtain tumor genetic information which could be used to guide critical treatment decisions.

scholarly journals Acute disseminated encephalomyelitis followed by recurrent or monophasic optic neuritis in pediatric patients

2012 ◽  
Vol 19 (7) ◽  
pp. 941-946 ◽  
Author(s):  
Peter Huppke ◽  
Kevin Rostasy ◽  
Michael Karenfort ◽  
Brenda Huppke ◽  
Rainer Seidl ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Optic Neuritis ◽  
Pediatric Patients ◽  
Case Series ◽  
Acute Disseminated Encephalomyelitis ◽  
Oligoclonal Bands ◽  
Central Nervous System Disorders ◽  
Established Disease

Background: Some pediatric patients with inflammatory demyelinating central nervous system disorders cannot be classified under any of the established disease entities, making their treatment and prognosis difficult. Objective: The objective of this study is to characterize a subgroup of pediatric patients with recurrent demyelinating central nervous system disorders. Methods: This study includes a case series of pediatric patients with monophasic or recurrent acute disseminated encephalomyelitis (ADEM) who later presented with either monophasic or recurrent optic neuritis (ON). Results: We describe seven patients with a median follow-up of six years (five females, two males) who presented at a median age of 6 years (range 4–8 years) with monophasic ( n = 4) or recurrent ADEM (two to four attacks) followed by monophasic ( n = 3) or recurrent ON (two to nine attacks). Cranial magnetic resonance imaging (MRI) was typical for ADEM ( n = 6) with complete or almost complete resolution of lesions on follow-up. Cerebrospinal (CSF) studies at the time of ADEM showed a pleocytosis in six patients and were negative for oligoclonal bands (OCBs) in all. In all patients high titers for serum anti-MOG antibodies were detected. Conclusion: ADEM followed by ON is a rare but distinct clinical phenotype among pediatric patients. Further studies are needed to allow recommendations on treatment or prognosis.

scholarly journals Galactomannan and PCR in the Central Nervous System to Detect Invasive Mold Disease - A Retrospective Analysis in Immunocompromised Children

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Thomas Lehrnbecher ◽  
Peter Michael Rath ◽  
Andishe Attarbaschi ◽  
Gunnar Cario ◽  
Michaela Döring ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Infectious Complication ◽  
Pediatric Patients ◽  
Immunocompromised Patients ◽  
Chain Reaction ◽  
The Central Nervous System ◽  
Polymerase Chain ◽  
Pcr Assays ◽  
Work Up

Abstract Invasive mold disease (IMD) of the central nervous system (CNS) is a severe infectious complication in immunocompromised patients, but early microbiological diagnosis is difficult. As data on the value of biomarkers in the CNS are scarce, in particular in children, we retrospectively analyzed the performance of galactomannan (GM) and PCR assays in CNS samples of 15 children with proven and probable CNS IMD and of 32 immunocompromised children without fungal infection. Galactomannan in the cerebrospinal fluid (CSF) was assessed in nine of the 15 pediatric patients and was positive in five of them. Polymerase chain reaction (PCR) was performed in eight of the 15 patients and detected nucleic acids from molds in six patients. Galactomannan and PCR in CNS samples were the only positive microbiologic parameter in the CNS in three and two patients, respectively. In four patients, PCR specified the pathogen detected in microscopy. Galactomannan and PCR results remained negative in the CSF of all immunocompromised children without evidence for CNS IMD. Our data suggest that GM and PCR in CNS specimens are valuable additional tools in diagnosing CNS IMD and should be included in the work up of all pediatric patients with suspected mold disease of the CNS.

scholarly journals (1→3)-β-d-Glucan in Cerebrospinal Fluid as a Biomarker forCandidaandAspergillusInfections of the Central Nervous System in Pediatric Patients

2015 ◽  
Vol 5 (3) ◽  
pp. 277-286 ◽  
Author(s):  
Christine M. Salvatore ◽  
Tempe K. Chen ◽  
Sima S. Toussi ◽  
Patricia DeLaMora ◽  
Ruta Petraitiene ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Pediatric Patients ◽  
The Central Nervous System
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