Journal of Pediatric Neurology - Volume 10, issue 2

Authors: Mordekar, Santosh R. | Prasad, Manish | Smith, Nigel J. | Vyas, Harish | Ross, Caroline | Jaspan, Timothy | Whitehouse, William P.

Article Type: Research Article

Abstract: The presence of an alpha pattern on electroencephalography is well described in patients with coma following trauma, hypoxia, metabolic dysfunction and cardiorespiratory arrest. This is generally regarded as an adverse prognostic factor especially the non-reactive complete form. We report a 15-year-old girl with complete alpha coma following head injury, who subsequently made a good physical recovery. We believe that this case should help pediatric neurologists, intensivists and neurophysiologists in the future, …who have to make difficult management decisions and will inform their discussions with the child's parents or guardians. Show more

Keywords: Traumatic brain injury, EEG, alpha coma, prognosis, BAEP

DOI: 10.3233/JPN-2012-0545

Citation: Journal of Pediatric Neurology, vol. 10, no. 2, pp. 137-141, 2012

Authors: Suresh, Natarajan | Rao, Nagaraja | Thiruvengadam, Vasanthi | Viswanathan, Venkataraman

Article Type: Research Article

Abstract: Diphtheritic neuropathy seldom has been observed nowadays in India beyond 1980 probably due to effective immunization. We report an 11-year-old adolescent girl, not adequately immunized who had pharyngitis with bull neck and subsequently presented with palatal weakness, accommodation paralysis, lower cranial nerve palsy and peripheral neuropathy, features characteristic of diphtheritic neuropathy. She was managed with supportive treatment. The specific treatment (diphtheria antitoxin) was not useful in our child as the child presented …4 wk after diphtheria infection. This case report will increase the awareness of sporadic occurrence of a rare disease among fellow pediatricians. Show more

Keywords: Diphtheria, neuropathy, immunization

DOI: 10.3233/JPN-2012-0546

Citation: Journal of Pediatric Neurology, vol. 10, no. 2, pp. 143-145, 2012

Authors: Mondal, Rakesh | Sarkar, Sumantra | Ghosh, Jayanta | Saren, Abhisek

Article Type: Research Article

Abstract: Leukemia is the most common malignancy in children. There were different atypical presentations of acute leukemia described in literature like cardiac metastasis, maxillofacial mass etc. Macrocephaly as a presentation of acute lymphoblastic leukemia is reported earlier. We describe a 3-year-old male who presented with macrocephaly and chronic raised intracranial pressure, which was subsequently diagnosed to be case of acute promyelocytic leukemia. This pointed out that macrocephaly could even be a rare and early manifestation of …acute myeloid leukemia in children. Show more

Keywords: Macrocephaly, leukemia

DOI: 10.3233/JPN-2012-0549

Citation: Journal of Pediatric Neurology, vol. 10, no. 2, pp. 147-149, 2012

Authors: Yaman, Halil | Karaoglu, Abdulbaki | Cayci, Tuncer | Akgul, Emin Ozgur | Kurt, Yasemin Gulcan | Tunc, Turan | Vurucu, Sebahattin

Article Type: Research Article

Abstract: In this paper, we report a case of a 5-year-old girl whose intractable seizures ceased after introduction of a lactose free diet. Because of epileptic seizures, antepileptic agents and vagal nerve stimulation treatment were applied to the patient, who had mental and motor retardation, over a period of 4 years. Despite treatments, seizures were refractory. An electroencephalogram showed a continuous pattern of generalized discharges briefly attenuated by short periods of suppression. A lactose tolerance test …was performed and lactose intolerance was diagnosed. A lactose-free diet was given and after this diet was applied, no further seizures were seen. Galactose deficiency due to lactose intolerance might have been the cause of motor and mental retardation in this patient. We speculate that lactose intolerance should be considered in the differential diagnosis of intractable seizures. Early diagnosis of lactose intolerance may prevent motor and mental retardation. Show more

Keywords: Lactose intolerance, seizure, child

DOI: 10.3233/JPN-2012-0551

Citation: Journal of Pediatric Neurology, vol. 10, no. 2, pp. 151-154, 2012

Authors: Prasad, Manish | Ramdas, Sithara | Abu-Arafeh, Ishaq

Article Type: Research Article

Abstract: Our aim is to describe the difficulties in the diagnosis and treatment of a child with continuous unilateral headache. We present the case of a 12-year-old child who had a two year history of continuous dull pain behind the right ear with frequent episodes of severe sharp pain as well as ipsilateral color change on the cheek. We assess the role of international classification of headache disorders in establishing the diagnosis and we assess the treatment …options. The international classification of headache disorders criteria for the diagnosis of hemicrania continua are, based on experience with adults and may not be adequate in children. The child had a very poor quality of life due to his illness and failed to respond to indomethacin among many other medications. However, he responded well to treatment with botulinum toxin type-A on two occasions. Childhood hemicrania continua may have a different phenotype than that in adults. Botulinum toxin type-A may be an option for treatment in some patients. Show more

Keywords: Botulinum toxin type-A (Botox), hemicrania continua, tension type headache, paroxysmal hemicrania continua

DOI: 10.3233/JPN-2012-0552

Citation: Journal of Pediatric Neurology, vol. 10, no. 2, pp. 155-159, 2012

Authors: Mohammed, Elsayed A. | Jan, Mohammed M.S.

Article Type: Research Article

Abstract: Kleine-Levin syndrome~is an exceptionally rare disorder characterized by recurrent episodes of hypersomnia associated with varying degrees of behavioral or cognitive disturbances and compulsive eating behavior. The disorder occurs predominantly in adolescent males with a benign clinical course and spontaneous remission as long as other neurological or psychiatric diseases are excluded. A viral or an autoimmune etiology has been suggested as up to 70% of patients have flu-like symptoms at the onset of their symptoms. …In this report, we present a 9-year-old female patient with this rare disorder and review the relevant pediatric literature. She was previously healthy and presented with a 1-month history of generalized fatigue, excessive sleep and behavioral change. She would sleep for most of the day even while sitting and would resist being awakened. During brief periods of wakefulness, her mood will fluctuate from apathy to anger, sadness and aggression for minimal reasons. She would eat and drink excessively with a notable weight gain. Clinical examination and detailed investigations, including brain computerized tomography scan and electroencephalography were within normal limits. Remarkable improvement of her symptoms was noted after initiating methylphenidate and carbamazepine. We conclude that Kleine-Levin syndrome is an interesting rare disorder that needs to be diagnosed after excluding other causes of excessive sleep. Early recognition would result in appropriate treatment and shortened period of hospitalization. Show more

Keywords: Kleine-Levin syndrome, child, sleep, hypersomnia

DOI: 10.3233/JPN-2012-0553

Citation: Journal of Pediatric Neurology, vol. 10, no. 2, pp. 161-164, 2012

Authors: Khan, Arif | Gertz, Süna | Hussain, Nahin

Article Type: Research Article

DOI: 10.3233/JPN-2012-0550

Citation: Journal of Pediatric Neurology, vol. 10, no. 2, pp. 165-166, 2012