Hypertensive Encephalopathy

Mostafa SHARIFIAN

Iranian Journal of Child Neurology, Vol. 6 No. 3 (2012), 24 September 2012 , Page 1-7
https://doi.org/10.22037/ijcn.v6i3.3530

How to cite this article: Sharifian M. Hypertensive Encephalopathy. Iran J Child Neurol 2012; 6(3):1-7.

Hypertension is called the silent killer and vital organs such as the brain, eyes,kidneys and the heart are the targets. Seizure, central nervous system (CNS)hemorrhage, and cerebrovascular accident (CVA), blindness and heart attacksare the end points.The prevalence of hypertension in children is much less than adults, but evidencereveals that the source of hypertension in adulthood goes back to childhood. In70-80% of cases hypertension is due to renal diseases. In children, hypertensiveencephalopathy (HE) may be the first manifestation of renal diseases. Seizure isone of the most common manifestations of HE.In this article, definitions, etiology, pathophysiology and finally the acute andchronic managements of HE will be discussed.

References

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Therapeutic effect of insulin in reduction of critical illness polyneuropathy and Myopathy in pediatric intensive care unit

nemat BILAN, Shahram SADEGVAND, Shirin RANJBAR

Iranian Journal of Child Neurology, Vol. 6 No. 3 (2012), 24 September 2012 , Page 9-13
https://doi.org/10.22037/ijcn.v6i3.3161

How to Cite this Article: Fayyazi A, Karimzadeh P, Torabian S, Damadi S, Khaje A. Comparison of Intravenous Midazolam Drip with Intermittent Intravenous Diazepam in The Treatment of Refractory Serial Seizures in Children. Iran J Child Neurol 2012; 6(3): 15-19.

Objective

Hyperglycemia may occur in the patients affected by any kind of critical illness.This complication makes an adverse effect on the clinical outcome of thesepatients by causing polyneuropathy and myopathy. It has been recently shownthat treatment of hyperglycemia with insulin administration significantly reducesthe prevalence of critical illness polyneuropathy and myopathy (CIPNM) andon the other hand reduces the demand for long-term mechanical ventilation inthe patients admitted to the ICU for more than 1 week. The aim of this studywas to determine the therapeutic effect of insulin in reducing the incidence ofCIPNM in the pediatric intensive care unit (PICU).

Materials & Methods

In this study, we recruited 30 patients admitted to the PICU of Tabriz PediatricHospital. The incidence of CIPNM following hyperglycemia was evaluated inthese patients. The patients were categorized into two groups. In the case group,blood sugar was controlled in the range of 140-180mg/dl by administration of0.05 unit per kilogram body weight of insulin as drip protocol in an hour and inthe control group, placebo was used. Consequently, the incidence of CIPNM,duration of PICU and duration of mechanical ventilation were comparedbetween the two groups.

Results

The incidence of CIPNM and duration of PICU stay and mechanical ventilationwere significantly reduced in the patients treated with insulin compared to thecontrol group.

Conclusion

This study shows that blood sugar control decreases the incidence of CIPNM.

References

  1. Van den Berghe G. Insulin therapy in critical illness. Can J Diabetes. 2004;28(1):43-9.
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  7. Wiener RS, Wiener DC, Larson RJ. Benefits and risks of tight glucose control in critically ill adults: a meta analysis.JAMA 2008 Aug;300(8):933-44.
  8. 8. Griesdale DE, de Souza RJ, van Dam RM, Heyland DK,Cook DJ, Malhotra A et al. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. CMAJ 2009 Apr;180(8):821-7.
  9. Mraovic B. Continuous glucose monitoring during intensive insulin therapy. J iabetes Sci Technol 2009 Jul;3(4):960-3.
  10. De Jonghe B, Bastuji-Garin S, Sharshar T, Outina,H, Brochard L. Does ICU-acquired paresis lengthen weaning from mechanical ventilation? Intensive Care Med 2004 Jun;30(6):1117-21.
  11. Garnacho-Mantero J, Amaya-Villar R, García-Garmendía JL, Madrazo-Osuna J, Ortiz-Leyba C. Effects of criticallillness polyneuropathy on the withdrawal from mechanical ventilation and the length of stay in septic patients. CritCare Med 2005 Feb;33(2):349-54.

Comparison of Intravenous Midazolam Drip with Intermittent Intravenous Diazepam in the Treatment of Refractory Serial Seizures in Children

Afshin FAYYAZI, Parvaneh KARIMZADEH, Saadat TORABIAN, Somayeh DAMADI, Ali KHAJEH

Iranian Journal of Child Neurology, Vol. 6 No. 3 (2012), 24 September 2012 , Page 15-19
https://doi.org/10.22037/ijcn.v6i3.3532

How to Cite this Article: Fayyazi A, Karimzadeh P, Torabian S, Damadi S, Khaje A. Comparison of Intravenous Midazolam Drip with Intermittent Intravenous Diazepam in The Treatment of Refractory Serial Seizures in Children. Iran J Child Neurol 2012; 6(3): 15-19.

 

Objective

Serial seizures occur commonly in inpatient epileptic children. This type ofseizure due to its characteristics has a significant impact on the patient’s health.Untreated serial seizures lead to status epilepticus; therefore, finding a moreeffective treatment for such patients is essential. This study was performed tocompare the outcome of intermittent intravenous diazepam in the pediatricneurology clinic and intravenous midazolam in the pediatric intensive care unit(PICU), in order to introduce an alternative treatment for serail seizures.

Materials & Methods

In this study, 38 inpatient children aged 6 mo-15 years with refractory serialseizures were treated by first line antiepileptic drugs and then randomlytreated with either intermittent intravenous diazepam in the neurology ward orintravenous midazolam in PICU.

Results

Fourteen (70%) diazepam group patients and 13 (72.2%) midazolam grouppatients had good response to treatment, there was no significant differencebetween the two groups. Four midazolam group patients and two diazepamgroup patients needed mechanical ventilation and were intubated duringtreatment, with no significant difference between the two groups. Durationsof mechanical ventilation and PICU and hospital stay were not significantlydifferent between the two groups.

Conclusion

Intermittent intravenous diazepam is an effective alternative therapy formidazolam drip in the treatment of serial seizures due to similar therapeuticeffects and fewer side effects.

References

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Relationship Between Migraine and Abnormal EEG Findings in Children

Habibe NEJAD BIGLARI, Alireza REZAYI, Hamid NEJAD BIGLARI, Mehdi ALIZADEH, Farzad AHMADABADI

Iranian Journal of Child Neurology, Vol. 6 No. 3 (2012), 24 September 2012 , Page 21-24
https://doi.org/10.22037/ijcn.v6i3.3533

How to Cite this Article: Nejad Biglari H, Rezayi A, Nejad Biglari H, Alizadeh M, Ahmadabadi F. Relationship Between Migraine and Abnormal EEG Findings in Children. Iran J Child Neurol 2012; 6(3): 21-24.

Objective

Migraine is a disabling illness that causes absence from school andaffects the quality of life. It has been stated that headache may representan epileptic event. EEG abnormality is a prominent finding in children with migraine. The aim of this study was to evaluate EEG abnormalities in children with migraine.

Materials & Methods

Two-hundred twenty-eight children were enrolled into the study. Evaluation and following of cases was performed by one physician, paraclinical tests were used to increase the accuracy. The study wasconducted under the supervision of pediatric neurology masters and theselected cases were from different parts of the country.

Results

Comparing EEG abnormalities in different types of migraine revealed that there is an association between them. There was also a significant difference between EEG abnormalities in different types of aura. Migraine type was associated with the patient’s age. Sleep disorders were more common in patients with a positive family history of seizure.

Conclusion

Our study disclosed migraine as a common problem in children with abnormalities present in approximately 20% of the patients. Migraine and abnormal EEG findings are significantly associated.

References

  1. Ottman, R, Lipton RB, Comorbidity of migraine and epilepsy. Neurology 1994 Nov;44(11):2105-10.
  2. Haut SR, Bigal ME, Lipton RB. Chronic disorders with episodic manifestations: focus on epilepsy and migraine.Lancet Neurol 2006 Feb;5(2):148-57.
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Clinical and Para clinical Manifestations of Tuberous Sclerosis: A Cross Sectional Study on 81 Pediatric Patients

Seyyed Hassan TONEKABONI, Parviz TOUSI, Ahmad EBRAHIMI, Farzad AHMADABADI, Zarrintaj KEYHANIDOUT, Gholamreza ZAMANI, Morteza REZVANI, Susan AMIRSALARI, Azita TAVASSOLI, Alireza ROUNAGH, Alireza REZAYI

Iranian Journal of Child Neurology, Vol. 6 No. 3 (2012), 24 September 2012 , Page 25-31
https://doi.org/10.22037/ijcn.v6i3.3534

How to Cite this Article: Tonekaboni SH, Tousi P, Ebrahimi A, Ahmadabadi F, keyhanidoust Z, Zamani Gh, Rezvani M, Amirsalari S, Tavassoli A, Rounagh A, Rezayi A. Clinical and Para clinical Manifestations of Tuberous Sclerosis: A Cross Sectional Study on 81 Pediatric Patients. Iran J Child Neurol 2012; 6(3): 25-31.

Objective

Migraine is a disabling illness that causes absence from school andaffects the quality of life. It has been stated that headache may representan epileptic event. EEG abnormality is a prominent finding in childrenwith migraine. The aim of this study was to evaluate EEG abnormalitiesin children with migraine.

Materials & Methods

Two-hundred twenty-eight children were enrolled into the study.Evaluation and following of cases was performed by one physician,paraclinical tests were used to increase the accuracy. The study wasconducted under the supervision of pediatric neurology masters and theselected cases were from different parts of the country.

Results

Comparing EEG abnormalities in different types of migraine revealedthat there is an association between them. There was also a significantdifference between EEG abnormalities in different types of aura. Migrainetype was associated with the patient’s age. Sleep disorders were morecommon in patients with a positive family history of seizure.

Conclusion

Our study dosclosed migraine as a common problem in children withabnormalities present in approximately 20% of the patients. Migraineand abnormal EEG findings are significantly associated.

Refrences

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Results of Non-contrast Brain Computed Tomography Scans of 1-18 Year Old Epileptic Children

Razieh FALLAH, Reza NAFISI MOGHADAM, Mohammad FALLAH TAFTI, Mahdi SALMANI NODOUSHAN

Iranian Journal of Child Neurology, Vol. 6 No. 3 (2012), 24 September 2012 , Page 33-38
https://doi.org/10.22037/ijcn.v6i3.3547

How to Cite this Article: Fallah R, Nafisi Moghadam R, Fallah Tafti M, Salmani Nodoushan M. Results of Noncontrast Brain Computed Tomography Scans of 1-18 Year Old Epileptic Children. Iran J Child Neurol 2012; 6(3): 33-38.

Objective

The advent of computed tomography (CT) scan revolutionized the diagnosticevaluation of neurologic patients. The aim of this study was to evaluate brain CTresults of epileptic children.

Materials & Methods

In a descriptive cross-sectional study, noncontrast brain CT scan of 150 consecutive1-18 year old epileptic children whom were referred to pediatric neurology clinic ofShahid Sadoughi University of Medical Sciences, from May 2008 to October 2010 inYazd-Iran, evaluated.

Results

Sixty two girls and 88 boys with mean age of 6.6 ± 4.3 years were evaluated.In 38 (25.3 %) children, seizure onset age was under one year and 38 others hadabnormal mental / developmental status. Fifty three children (35.3 %) and 97 (64.7%)had partial and generalized seizures, respectively. Partial seizures were more prevalentin children with seizure onset in < 1 year [41.5% (22/53) vs. 16.5% (16/97)] Result of CT was normal in 74 % (n=111). Among the patients with abnormalresults, 18(46%) had brain atrophy, 10 (25.6%) structural CNS dysgenesia, six (15.4%)intracranial calcification, three (7.8%) hydrocephaly and two had (5.2%) brain tumor.Abnormal brain CT was more prevalent in patients with seizure onset in less than oneyear of age [60.5% (23 of 38) vs. 14.3% (16 of 112), p = 0.003], partial epilepsy [51% (27of 53) vs. 12% (12/97)], and abnormal developmental status [ 81.5% (31 of 38) vs.7% (8of 112]. Mean age of seizure onset in epileptic children with abnormal brain CT scanwas less (M ± SD:1/17 ± 0.6 years versus 4.02±1.9 years).

Conclusion

Brain CT scan might be considered in evaluation of epileptic children with partialseizures, seizure onset in less than one year of age or neurodevelopmental delay.

References

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Epilepsy as a Rare Neurologic Manifestation of Oculodentodigitalis Dysplasia

Mohammad BARZEGAR, Mohammad SAYADNASIRI, Aidin TABRIZI

Iranian Journal of Child Neurology, Vol. 6 No. 3 (2012), 24 September 2012 , Page 39-43
https://doi.org/10.22037/ijcn.v6i3.3535

How to Cite this Article: Barzegar M, Sayadnasiri M, Tabrizi A. Epilepsy as a Rare Neurologic Manifestation of Oculodentodigitalis Dysplasia. Iran J Child Neurol 2012; 6(3): 39-43.

Oculodentodigitalis dysplasia (ODDD) is an extremely rare inherited disorderinvolving the development of the face, eyes, teeth and limbs. In addition,some patients develop neurological problems mostly a spastic paraparesisassociated with white matter abnormalities on magnetic resonance imaging.This report describes a patient with epilepsy, a rare neurologic manifestationof this syndrome.

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A Case Report of Congenital Insensitivity to Pain and Anhidrosis (CIPA)

Mehran KARIMI, Razieh FALLAH

Iranian Journal of Child Neurology, Vol. 6 No. 3 (2012), 24 September 2012 , Page 45-48
https://doi.org/10.22037/ijcn.v6i3.3536

How to Cite this Article: Karimi M, Fallah R. A Case Report of Congenital Insensitivity to Pain and Anhidrosis (CIPA). Iran J Child Neurol 2012; 6(3): 45-48.

 

Congenital insensitivity to pain and anhidrosis (CIPA) or hereditary sensoryautonomic neuropathies type IV (HSAN type IV) is an extremely rare autosomalrecessive disorder initially described by Swanson in 1963.We report a 2.5-year-old boy with clinical features of CIPA as the first case in Iran.The symptoms included recurrent episodes of hyperthermia and unexplainedfever that began in early infancy, anhidrosis (inability to sweat), profound lossof pain sensitivity, neurodevelopmental delay, unconscious self-mutilation offingers, lips and tongue, corneal lacerations, palmar hyperkeratosis, non-painfulfracture and joint deformities in the right ankle. Tearing, deep tendon reflexesand motor and sensory nerve action potentials were normal.Prenatal screening is the sole accessible option to prevent the birth of anaffected child as no cure is available. Early recognition of CIPA patients and itsorthopedic complications, prevention of accidental injuries, regular visual andeye follow-up and specific dental management could be useful in the reductionof frequency and severity of complications.

 

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