Childhood central nervous system vasculitis

Benseler, Susanne M.; Pohl, Daniela

doi:10.1016/b978-0-444-52910-7.00024-6

Cited by 24 publications

(19 citation statements)

References 90 publications

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“…21 In both our cases, clinical worsening prompted the initiation of steroid therapy in accordance with published recommendations for the treatment of central nervous system vasculitis, although the evidence supporting specific treatments of vasculitis especially secondary to infection is limited. 23 Current guidelines for the management of stroke in children have been developed by the American Heart Association/American Stroke Association, 3 the American College of Chest Physicians, 24 and the Royal College of Physicians, 25 all based on expert consensus rather than trial data. Recommendations vary for acute treatment immediately following first stroke, with 1 recommending aspirin, 25 1 recommending anticoagulation, 3 and 1 recommending either 24 while etiologic workup is ongoing.…”

Section: Discussionmentioning

confidence: 99%

Cerebrovascular Complications of Pediatric Pneumococcal Meningitis in the PCV13 Era

Bernson-Leung

Lehman

2016

Hospital Pediatrics

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A previously healthy, full-term 5-month-old girl presented to the emergency department with a 1-day history of fever to 103°F, emesis, poor feeding, and progressive lethargy. She had recently started day care. The patient had received her routine 2-and 4-month childhood vaccines on schedule, including the 13-valent pneumococcal conjugate vaccine (PCV13). Initial examination revealed decreased responsiveness, rightward gaze preference, decreased movement of the left side, and positive Brudzinski sign. Laboratory testing is as in Table 1. Ceftriaxone and vancomycin were started at meningitic dosing. Cerebrospinal fluid grew Streptococcus pneumoniae serotype 33F, a nonvaccine serotype. Case 2A previously healthy 21-month-old boy presented to the emergency department with a 1-day history of fever to 103°F, emesis, cough, and lethargy. Rapid influenza testing was positive for influenza A, and oseltamivir was started. History was notable for day care attendance and multiple sick contacts. He was fully immunized, including PCV13.The next morning, he had a brief seizure with eye deviation and generalized convulsions, and became obtunded. Simultaneously, blood culture grew gram-positive cocci in pairs and chains. He returned to the emergency department, where he had right-sided weakness, posturing, rightward eye deviation, and meningismus as well as further seizures requiring lorazepam and fosphenytoin. Laboratory testing is as in Table 1. Ceftriaxone and vancomycin were started at meningitic dosing. Cerebrospinal fluid grew S pneumoniae serotype 15B, a nonvaccine serotype.

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Section: Discussionmentioning

confidence: 99%

Cerebrovascular Complications of Pediatric Pneumococcal Meningitis in the PCV13 Era

Bernson-Leung

Lehman

2016

Hospital Pediatrics

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“…Disease course can be chronic unremitting, or characterized by periods of remission and relapses. 114 MRI of the brain in SVcPACNS commonly shows multifocal inflammatory involvement of the brain and/or of the spinal cord. The optic nerve can also be affected.…”

Section: N-methyl D-aspartate Receptor Encephalitismentioning

confidence: 99%

“…Brain lesions are variable, ranging from extensive areas of signal change involving both white and gray matters to nonspecific punctate white matter lesions. 114 Inflammatory lesions are typically hyperintense on T2/FLAIR and variably hypointense on T1-weigthed sequences, and do not generally present with diffusion restriction except in cases with a significant ischemic component. 114 Lesional contrast enhancement and leptomeningeal enhancement are variably reported; leptomeningeal enhancement, in particular, should prompt consideration of SVcPACNS (provided that CNS infection has been excluded).…”

Section: N-methyl D-aspartate Receptor Encephalitismentioning

confidence: 99%

“…114 Inflammatory lesions are typically hyperintense on T2/FLAIR and variably hypointense on T1-weigthed sequences, and do not generally present with diffusion restriction except in cases with a significant ischemic component. 114 Lesional contrast enhancement and leptomeningeal enhancement are variably reported; leptomeningeal enhancement, in particular, should prompt consideration of SVcPACNS (provided that CNS infection has been excluded). 114,115 Inflammatory brain abnormalities may present interval progression, remain quiescent, or resolve over time or after immunotherapy.…”

Section: N-methyl D-aspartate Receptor Encephalitismentioning

confidence: 99%

“…114 Lesional contrast enhancement and leptomeningeal enhancement are variably reported; leptomeningeal enhancement, in particular, should prompt consideration of SVcPACNS (provided that CNS infection has been excluded). 114,115 Inflammatory brain abnormalities may present interval progression, remain quiescent, or resolve over time or after immunotherapy. 114 Diffuse or focal atrophic changes may occur as sequelae of SVcPACNS.…”

Section: N-methyl D-aspartate Receptor Encephalitismentioning

confidence: 99%

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Neuroimaging in Pediatric Autoimmune Diseases

Longoni

Banwell

2017

J Pediatr Neurol

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Magnetic resonance imaging plays an essential role in the diagnosis and management of pediatric central nervous system (CNS) autoimmune disorders. This article reviews the key clinical and conventional neuroimaging characteristics of the most frequent entities of the demyelinating disease spectrum, with a goal to inform and guide decisions in the clinical practice. We focus on acquired demyelinating syndromes and their differential diagnoses including mimics such as systemic inflammatory disorders with secondary CNS involvement. In the vast majority of disorders, no specific biomarker of disease is known and the final diagnosis is based on recognizable syndromic characteristics. Therefore, familiarity with the related neuroimaging patterns can improve a timely diagnosis of pediatric autoimmune diseases and prompt targeted therapeutic approach.

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