Brain developmental impairment occurs in many infants with congenital heart disease, especially in those who have preoperative hypoxia and critical congenital heart disease. This quantitative volumetric study encourages larger scale and longitudinal follow-up to elucidate the significance of impaired neuroanatomic development on functional outcome.

The clinical and epidemiological findings in children with epilepsy who experienced skin rashes induced by carbamazepine (CBZ) were prospectively evaluated. Thirty-three (9.9%) of 335 patients who received CBZ therapy experienced a skin rash. Seven had diffuse erythema, 13 miliary exanthema, 11 maculopapular or speckled reddish rash, 3 petechiae, and 2 mucocutaneous syndrome. A skin rash was more frequent in older children (over 6 years old). The skin rashes appeared soon after initiation of the therapy, i.e., from the 8th to 60th day (mean: 14.3 +/- 9.6 days) after the start of CBZ therapy and disappeared within a few days after discontinuation of the therapy. Haematological abnormalities (30.3%), such as leucocytopenia and thrombocytopenia, and hepatic dysfunction (27.3%) sometimes appeared concomitantly with the skin rash. CBZ is an effective and safe antiepileptic drug, but careful management is necessary on initiation of the therapy.

A lesion of sporotrichosis shows a characteristic arrangement of the infiltrate in three zones: the central suppurative zone composed of polymorphonuclear leukocytes, the tuberculoid zone and the round cell zone. For investigating the pathomechanism of the suppurative zone formation, polymorphonuclear leukocyte chemotaxis to sporotrichin was assayed with the agarose plate method. Polymorphonuclear leukocytes in the patients with sporotrichosis showed an enhanced chemotactic index in comparison with that in the control subjects. However, there was no difference in non-specific chemotaxis to bacteria-derived substance between the patients and the control subjects.

Key words acute cerebellar ataxia, Epstein-Barr virus, infectious mononucleosis, T cell receptor Vb repertoires.Most primary Epstein-Barr virus (EBV) infections are asymptomatic; however, such infections can cause infectious mononucleosis (IM), which is characterized by a prolonged fever, cervical lymphadenopathy, hepatosplenomegaly, and peripheral lymphocytosis with atypical lymphocytes. IM is sometimes associated with neurological complications, including meningitis, encephalitis, acute demyelinating encephalomyelitis, cranial nerve palsy, cerebellitis, myelitis, and visual seizure with metamorphopsia, that is, "Alice in Wonderland" syndrome. 1,2 Here we describe a case of acute cerebellar ataxia associated with a primary EBV infection and discuss its pathogenesis. Case ReportA 7-year-old boy developed fever and a sore throat and visited a local hospital, where antibiotics (cefditoren pivoxil) were administered. Three days later he had skin eruptions on his hips and thigh. The eruption thereafter expanded over his face and back, but subsided within a few days. Eight days later, he presented with ataxia and a gait disturbance. On the next day, he also had dysphasia and was admitted to Toyama University Hospital. His medical history included bronchial asthma at 3 years of age, Kawasaki disease at 4 years of age and allergic rhinitis at 7 years of age.A physical examination at the time of his admission revealed the patient to be febrile, but his consciousness was alert. A general examination showed bilateral tonsillitis, but no lymphadenopathy or hepatosplenomegaly. A neurological examination revealed the deep tendon reflexes to be diminished and the Babinski reflex was negative. He showed a normal finger-nose test and no tremors, but ataxia in his trunk and a gait disturbance were observed. In addition, a speech disturbance was observed.Laboratory studies showed mild leukocytosis (9470/mL) with 46.5% neutrophils, 2% eosinophils, 4.5% monocytes, 37% lymphocytes, and 9% atypical lymphocytes. Other studies including electrolytes and liver function were normal. No Streptococcus pyogenes or adenovirus were detected with a throat swab culture. Cerebrospinal fluid (CSF) analysis revealed 1/3 leukocytes/mL, a protein of 20.1 mg/dL and a glucose of 61 mg/dL. A serological test for EBV showed viral capsid antigen (VCA)-immunoglobulin (Ig) G of 1 : 1280, VCA-IgM of 1 : 160, early antigen (EA)-IgG < 1 : 10, EA-IgM < 1 : 10, EBV nuclear antigen <1 : 10, thus indicating a primary EBV infection. A polymerase chain reaction (PCR) analysis for EBV was positive (521 copies/mL) in the serum, but negative in the CSF. A lymphocyte subset analysis showed an increased number of human leukocyte antigen-DR-positive (activated) CD3 + T cells (55%) and an inverted CD4/CD8 ratio (9.6%/54% = 0.18), thus suggesting a primary EBV infection.Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain revealed no abnormalities. Brain singlephoton emission computed tomography (SPECT) showed a mild hypoperfusion in the bilateral cere...

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