Alternating hemiplegia of childhood: clinical manifestations and long-term outcome

Alternating Hemiplegia of Childhood: Report of Two Cases

“…Attacks are frequently associated with triggers, most commonly environmental (temperature extremes, odors) but also water exposure, physical activities (exercise, swinging), lights (sunlight, fluorescent bulbs), or foods (chocolate, food dye). 5,6 In this report, the onset was at 9 month in the first one and 3½ months in the second one. Both had flaccid areflexic hemiparesis lasting few hours to 3 days.…”

“…They can be focal clonic, generalized tonic clonic or myoclonic. 5 One of the cases presented here had early onset epilepsy. Seizure was initially partial tonic, then atonic and subsequently tonic clonic.…”

“…4 Since this disease occurs so infrequently and is variable in presentation, knowledge of the clinical characteristics, response to treatment, and prognosis are based on few small cohort studies. 5,6 The onset of the disease occurs in first few months of life. The hemiplegic attacks usually last few minutes to several days and are associated with slowly progressive neurologic deficits over years.The syndrome begins with abnormal ocular movements (nystagmus, esotropia, exotropia) or dystonia in a majority of patients by three months of age.…”

“…Ictal electroencephalogram during episodes of hemiplegia may be normal or show slowing. 5 We have investigated both the patients with neuroimaging (CT scan, MRI and MRA) which showed normal findings. The patient with epilepsy had generalized epileptic discharge.…”

Dry tap and spinal anesthesia

“…Checking adjunctive airway equipment properly can help prevent equipment-related morbidity and mortality, improve preventative maintenance, and educate the anesthesia provider about the equipment. [3][4][5] In conclusion, our report alerts anesthesiologists to the possibility of breakage of MF and to the importance of proper scrutiny of all anesthesia-related equipment. …”