Journal de neurologie et médecine pédiatriques

Background: Human parechovirus type 3 (HPeV3) is an important cause of acute encephalitis in the neonatal and early infantile periods. Typical HPeV3-associated acute encephalitis paradoxically shows no cerebrospinal fluid (CSF) pleocytosis despite virus detection in CSF and diffuse deep white matter involvement of the corpus callosum on magnetic resonance images (MRI).

Patient: An 8-day-old full-term infant was found to have HPeV3 infection of the central nervous system (CNS), which was confirmed using diffusion-weighted MRI showing poor diffusivity in the bilateral deep white matter and the corpus callosum without CNS pleocytosis, as seen in previously reported cases. Interestingly, this patient had extremely elevated serum ferritin and urinary beta-2-microglobulin levels, which indicated a surge of the cytokines tumor necrotizing factor alpha and interferon gamma.

Conclusion: These findings suggest that the cytokine storm can promote the pathogenesis of white matter lesions in HPeV3-associated acute encephalopathy rather than direct infection of the brain.

Introduction: The incidence of pediatric stroke is 1.29-13.0 per 100,000 annually. Use of fibrinolytic therapy in qualified adults with acute ischemic stroke is standard practice. However, alteplase is not recommended in pediatric patients.

Case: We report a case of a 16 year old Caucasian female who presented to the emergency room with aphasia and right arm numbness one hour and twenty minutes after symptom onset. National Institutes of Health Stroke Scale (NIHSS) was three. Initial computed tomography without contrast showed a hyper-dense left middle cerebral artery (MCA).

The patient was below the minimum age for alteplase administration in acute ischemic stroke. Written consent was obtained from the parents and 90 mg alteplase (0.9 mg/kg; 90 mg maximum) was administered 3 h 25 min after symptom onset. Right arm numbness resolved thirty minutes after drug administration and repeat NIHSS was one for mild expressive aphasia.

Diffusion-weighted MRI the following day demonstrated infarction of the posterior left insular cortex while sparing most of the MCA distribution. She remained stable during hospitalization and was discharged home on daily aspirin and resumed school activities with full recovery.

Discussion: Although stroke is among the top ten causes of mortality in this age group, there are many barriers to administration of alteplase. Use of alteplase in the pediatric population is poorly reported and there are no randomized trials conducted in this age group. Due to the challenges in conducting randomized controlled trials in children, registries provide an alternative approach to gathering and analyzing information. Clinicians are encouraged to continue reporting cases of alteplase use in pediatric stroke patients.

Status epilepticus (SE) in childhood is a life threatening condition with serious risk of neurological sequelae and constitutes a medical emergency. The aim of this study is to provide data on the prevalence, aetiology and outcome of status epilepticus in children at the Wesley Guild Hospital, Ilesa, South-West Nigeria. We prospectively studied all the 276 children who were admitted with convulsion over a period of seven months, out of which 39 (14.1%) had status epilepticus. The cause of status epilepticus in 82.1% of the patients was cerebral malaria; other causes were febrile convulsion, meningitis, seizure disorders and head injury. The mortality and morbidity (neurologic sequelae at discharge) in this study were 23.1% and 33.3%, respectively. Mortality and morbidity were significantly higher in children who had status epilepticus compared to those who convulsed but did not have status. (χ²=33.773, df=1, p<0.001), (χ²=43.991, df=1, p<0.001).

In conclusion, morbidity and mortality of SE is high and control of malaria will most likely reduce the prevalence and improve the outcome of SE in this environment.