Está en la página 1de 4

TRANSVERSE MYELITIS 1. What is it?

Neurological disorder caused by inflammation across both sides of one level, or segment, of the spinal cord. 2. Causes? Auto immune, post vaccination or post viral infection. 3. Clinical features: Initial symptoms usually include localized lower back pain, sudden paresthesias , sensory loss, and paraparesis feeling of discomfort, headache, fever, and loss of appetite. Depending on which segment of the spinal cord is involved, some patients may experience respiratory problems as well. From this wide array of symptoms, four classic features of transverse myelitis emerge: (1) weakness of the legs and arms, (2) pain, (3) sensory alteration, and (4) bowel and bladder dysfunction. Pain is the primary presenting symptom of transverse myelitis. 4. Examination: Paresthesia, motor weakness, spasticity, hypereflexia & Positive Babinski. 5. Investigations: MRI and anti ds DNA 6. Treatment: NSAIDS for pain relieve Prednisolone or dexamethasone to stop inflammation. Physiotheray & occupational therapy to gain use of affected muscles & prevent atrophy.

STROKE IN CHILDHOOD DEFINITION: Focal neurological deficit with a vascular basis lasting more than 24 hours INCIDENCE: In pre CT era: 1.2-2.52/100 00 children/year In CT era: Incidence is 13/100,000 children / year (7.91/ 100,000 for ischemic stroke and 5.11/100,000 hemorrhagic stroke EIOLOGY: Ischemic stroke Cardiac disease Congenital heart disease Infective endocarditis Valvular disease Arrhythmias Hematologic Sickle cell disease

Inherited coagulopathy Myeloproliferative Disorders Primary vasculopathy Fibromuscular dysplasia Infections Takayasu arteritis SLE and other autoimmune diseases Infectious vasculitis Trauma Cervical spine rotation or Dislocation Metabolic Homocystinuria Surgical intervention Cardiac surgery Cardiac catheterization Cerebral angiography Neurocutaneous syndromes Neurofibromatosis Tuberous sclerosis Sturge Weber Hemorrhagic stroke Vascular malformations AVM Capillary telangiectasis Aneurysms Saccular Infective Hypertension Bleeding diathesis Factor deficiencies Thrombocytopenia DIC Leukemia Polycythemias Anticoagulant, thrombolytic therapy Vasculitis PATHOPHYSIOLOGY Cerebral embolism

Arterial thrombosis Venous thrombosis Intraparenchymal hemorrhage Lacunar infarction Subarachnoid hemorrhage CLINICAL PRESENTATION Hemiparesis (91%) Hemisensory signs Visual field defects Gaze palsy or head turning _ large supratentorial infarct Headache _ arterial dissection, cerebral venous thrombosis Seizures _ cerebral venous thrombosis, & neonatal stroke. LOC _ cerebral hemorrhage, large MCA territory infarct, posterior fossa stroke Embolism Onset Dramatic Sudden loss of function Symptoms depend on location & size of occluded vessel Most often associated with cardiac disease

Arterial Thrombosis Onset Subacute Prodromal symptoms, TIAs, stuttering course Venous thrombosis Variable Seizures ICP Altered mental status Focal neurologic signs Intraparenchymal hemorrhage Acute, of headache, vomiting, deterioration of function Sometimes subtle findings DIFFERENTIAL DIAGNOSIS Tumors Trauma CNS infection Demyelinating conditions Todds paresis Migraine INVESTIGATIONS

Neuroimaging MRI and MRA CT scan For those with hemorrhage Basic coagulation studies and platelet count Conventional angiography if no bleeding Diathesis For those with an infarct in a vascular distribution Total homocysteine (& thermolabile MTHFR gene, serum folate, B6, B12) Fasting cholesterol, triglycerides, Lp(a) lipoprotein Infection screen- Mycoplasma, Chlamydia, Helicobacter, Borrelia titers Serum and CSF titers to varicella zoster ECG, echocardiography, x-ray chest MANAGEMENT Anti-thrombotic : Aspirin 2-3 mg/kg/day Long term rehabilitation **anticoagulant not given after ischemic stroke in children- increase risk of hemorrhage

También podría gustarte