-Objective:To evaluate the effectiveness of dexamethasone as an adjunctive therapy to antibiotics in children with meningococcal meningitis. Method: A total of 81 children diagnosed with meningococcal meningitis hospitalized in sequence were studied at the University Hospital of São Paulo University, with the objective of evaluating the presence of sequelae in four different groups of patients, following the administration of dexamethasone: Group I -25 patients who received the first dose at least 10 minutes before the introduction of the antibiotic therapy; Group II -19 patients who received the corticosteroid concomitantly; Group III -14 patients for which the dexamethasone was administered after beginning the antibiotic scheme; Group IV -23 patients that did not receive dexamethasone. The groups were evaluated for homogeneity through the prognostic indexes and clinical and laboratory characteristics, based on the records obtained at hospitalization. Results: Some degree of sequelae occurred in 16 (26.22%) of the survivors and 23 patients (28.39%) coursed with sequelae or died. The mean period of neurological attendance was 36.97 months and neurological alterations were detected in 16.17% of the patients. No significant difference was found between the four groups. There was also no statistical difference in the comparison of the neurological sequelae in the children from group IV with the children of groups I and II or even with groups I, II and III analyzed as a whole. The presence of hearing loss occurred in 11.11% of the patients, again there was no significant difference between the four groups. Psychological evaluation was performed using the WPSSI and WISC tests. A mild mental disability was detected in one patient from group I and another in group III. The overall analysis of the sequelae (neurological, auditory and intellectual level) also did not demonstrate any significant difference between the four groups. Comparing the children from groups I and II together and also groups I, II and III as a whole with the children in group IV also failed to detect a significant difference arising from the use or nonuse of the corticosteroid. Conclusion: Dexamethasone was not proven to be effective in decreasing the number of sequelae among patients with meningococcal meningitis.KEY WORDS: sequelae, meningococcal meningitis, dexamethasone. Seqüelas de meningite meningocócica em crianças: análise crítica da utilização da dexametasonaRESUMO -Objetivo: Avaliar a eficácia da dexametasona como uma terapia adjunta à antibioticoterapia em crianças com meningite meningocócica. Método: Foram avaliadas 81 crianças com diagnóstico de meningite meningocócica e hospitalizadas sequencialmente no Hospital Universitário da Universidade de São Paulo, com o objetivo de avaliar a presença de sequelas em 4 diferentes grupos de pacientes, segundo a administração da dexametasona: Grupo I -25 pacientes, que receberam a primeira dose pelo menos 10 minutos antes da introdução da antibioticoterapia; Grupo II -19 pacientes que rec...

Norman & Tingey (1966) reported a new syndrome of micrencephaly, strio-cerebellar calcifications and leucodystrophy and in 1968, Lyon & col. reported the same syndrome plus dwarfism. These authors did not describe cerebrospinal fluid (CSF) alterations. In 1984, Aicardi & Goutièrres described 8 children from 5 different families with a syndrome like above referred to but with chronic CSF lymphocytosis; all patients had a progressive evolution, with familial character, with probable autosomic recessive heritage. It is the purpose of this report to relate a case similar to Aicardi & Goutièrres' cases in a male caucasian patient of jewish ashkenazim origin with 6 and a half month of age, but with a study of CSF lymphocytes T and B. Diminished T-subpopulations of active and avid-T were found suggesting local signalization of antibodies in the central nervous system. The differential diagnosis and that strange combination of a probable genetic etiology and an immunitary process revealing a local inflammatory process are discussed.

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OBJETIVO: Descrever um caso de síndrome de Kinsbourne manifestando-se com quadro de encefalite pós-viral e rever a da literatura. DESCRIÇÃO DO CASO: Criança do sexo feminino, dois anos e seis meses, encaminhada de outro serviço com história de ataxia, irritabilidade e dificuldades articulatórias na fala após episódio prodrômico de febre, lesões de pele e mucosa. Com hipótese de encefalite pós-viral, a avaliação clínica evidenciou quadro de síndrome opsoclônus-mioclonia-ataxia ou síndrome de Kinsbourne. Foi afastada a associação de neuroblastoma oculto e iniciada terapêutica com corticosteroide. Durante internação e acompanhamento ambulatorial, houve regressão progressiva e normalização do quadro clínico e neurológico inicial. COMENTÁRIOS: Apesar de se tratar de uma doença rara, o diagnóstico de síndrome de Kinsbourne deve ser reconhecido pelos pediatras e intensivistas, com objetivo de instituir tratamento específico precoce, embora com resultados variáveis, sendo fundamental a exclusão de neuroblastoma oculto.