Intravenous valproate for seizures in 137 Taiwanese children - valproate naive and non-naive.

Purpose: Valproate has been widely used in controlling various kinds of seizures. Intravenous forms of valproate control seizures in a more rapid and efficacious pattern than oral forms. We evaluated the effectiveness and adverse effects of intravenous valproate for controlling seizures in Taiwanese children under 18 years old.

Guillain-Barré syndrome presenting as mimicking croup.

Stridor is a commonly encountered presenting symptom of upper airway obstruction in the pediatric population. Although infection etiologies such as croup, retropharyngeal abscess, and epiglottitis predominate in the pediatric population, other less common etiologies must also be considered in the differential diagnosis. We report a case of 3-year-2-month-old girl who exhibited the following symptoms: progressive hoarseness, backing cough, and dyspnea.

An extra-axial hemangioma mimicking a large prenatal brain tumor.

A rare case of a congenital brain tumor was diagnosed by sonography in a fetus at 37weeks' gestation. The ultrasound examination showed a large area of both increased echogenicity and echolucency in one hemisphere suggestive of brain tumor or hemorrhage. Extensive surgical removal of the tumor was performed and revealed an extremely rare histological type of hemangioma.

Craniocervical arterial dissection: a cause of childhood arterial ischemic stroke in Taiwan.

Background/purpose: To describe the clinical characteristics and imaging findings of craniocervical dissection in childhood ischemic stroke, in a tertiary medical center.

Methods: In this retrospective study, we investigated children (aged 1 month to 18 years) with symptoms and radiographic confirmation of ischemic stroke from January 1996 to January 2007. Stroke work-up included neuroimaging (magnetic resonance imaging, computed tomography, conventional angiography, and magnetic resonance angiography), cardiac assessment, prothrombotic assays, immunoassays, infection screening, and metabolic screening.

Analysis of convulsive status epilepticus in children of Taiwan.

Convulsive status epilepticus is a medical emergency with significantly associated mortality and morbidity. The demographic data and outcomes of convulsive status epilepticus in children were collected for descriptive analysis. We retrospectively reviewed cases of convulsive status epilepticus in the Pediatric Intensive Care Unit of Chang Gung Children's Hospital between 1999 and 2006.

Non-accidental chlorpyrifos poisoning-an unusual cause of profound unconsciousness.

Chlorpyrifos is an organophosphorus anticholinesterase insecticide, and organophosphate intoxication can induce symptoms such as miosis, urination, diarrhea, diaphoresis, lacrimation, excitation of central nervous system, salivation, and consciousness disturbance (MUDDLES). Although accidental poisoning of children with drugs and chemicals is a common cause for consciousness disturbance in children, the possibility of deliberate poisoning is rarely considered. We report on a healthy 5-year 6-month-old boy with recurrent organophosphate intoxication.

Pericardial effusion with cardiac tamponade as a cardiac manifestation of Duchenne muscular dystrophy.

Duchenne muscular dystrophy (DMD) is the most common hereditary neuromuscular disease in children. It is an X-linked hereditary dystrophinopathy due to the absence of dystrophin. Its onset is often in early childhood and presents with proximal distribution of weakness and a progressive course.

Influenza-associated central nervous system dysfunction in Taiwanese children: clinical characteristics and outcomes with and without administration of oseltamivir.

Seventy-four of the 2651 patients (2.8%) with influenza aged <18 years had signs or symptoms of central nervous system dysfunction presenting to the hospital. None had oseltamivir exposure before the onset of central nervous system dysfunction.

Host and microbiologic factors associated with mortality in Taiwanese children with invasive pneumococcal diseases, 2001 to 2006.

We concurrently evaluated host- and organism-related factors in determining the outcomes of 160 invasive pneumococcal diseases episodes in 158 Taiwanese children during 2001 and 2006. Most (138/160, 86.2%) episodes occurred at age less than 60 months, and an underlying condition was present in 35 (22.

Combined central diabetes insipidus and cerebral salt wasting syndrome in children.

Central diabetes insipidus, a common consequence of acute central nervous system injury, causes hypernatremia; cerebral salt wasting syndrome can cause hyponatremia. The two conditions occurring simultaneous are rarely described in pediatric patients. Pediatric cases of combined diabetes insipidus and cerebral salt wasting after acute central nervous system injury between January 2000 and December 2007 were retrospectively reviewed, and clinical characteristics were systemically assessed.

Hemorrhagic stroke associated with pulmonary edema and catastrophic cardiac failure.

Cerebral arteriovenous fistula (AVF) is a vascular malformation that is rare in the pediatric population. Older children with cerebral AVF tend to present with neurologic problems related to intracranial venous hypertension or intracranial hemorrhage. Cardiac and pulmonary complications following acute neurologic injury such as subarachnoid hemorrhage are common in adults, but are rarely reported in children.

Tuberous sclerosis complex with multiple intracranial aneurysms in an infant.

Tuberous sclerosis complex is a protean, genetically determined disease that may involve any organ or tissue and lead to a great number of signs and clinical features. Occlusive vascular disease and aneurysms of the cerebral and visceral arteries were described in these patients. We report on an 8-month-old boy who manifested tuberous sclerosis complex with multiple intracranial aneurysms involving the internal carotid artery and middle cerebral artery.

Spontaneous pneumomediastinum due to gastroesophageal reflux disease in an adolescent boy.

The presence of free air in the mediastinum, without traumatic injury or underlying disease, is known as spontaneous pneumomediastinum. The diagnosis is based on CXR and CT scan. Oesophagography is essential for the exclusion of oesophageal rupture.

Cerebellar infarction in the territory of the superior cerebellar artery in children.

Posterior circulation infarction is uncommon in children. Vertebral artery dissection is an unusual cause of posterior circulation infarction in children. We report on a 12-year-old boy with spontaneous left-extracranial vertebral artery dissection associated with isolated ipsilateral superior cerebellar artery territory infarction, diagnosed clinically and by brain computed tomography, magnetic resonance imaging, and magnetic resonance angiography.

Prevalence of methicillin-resistant Staphylococcus aureus nasal colonization among Taiwanese children in 2005 and 2006.

From July 2005 to October 2006, a total of 3,046 children, of ages between 2 months and 5 years, presented for a well-child health care visit to one of three medical centers, which are located in the northern, central, and southern parts of Taiwan, and were surveyed for nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA). The overall prevalences of S. aureus and MRSA nasal carriage among the children were 23% and 7.

Occult infarct with acute hemorrhagic stroke in juvenile diabetic ketoacidosis.

Diabetes ketoacidosis (DKA) is one of the common complications of type I insulin-dependent diabetes mellitus. Neurological deterioration during an episode of DKA is usually assumed to be caused by cerebral edema and cerebral vascular accidents. However, hemorrhagic stroke is a very rare complication of juvenile DKA.

Analysis of status epilepticus related presumed encephalitis in children.

Objective: Encephalitis is an acute infection of brain parenchyma characterized clinically by fever, headache, and an altered level of consciousness. There may also be focal or multifocal neurologic deficits, and focal or generalized seizure activity. Here we report an analysis of status epilepticus (SE) related presumed encephalitis in a series of children.

Bullous impetigo: a rare presentation in fulminant streptococcal toxic shock syndrome.

Since the mid-1980s, an increase in incidence of invasive disease caused by group A streptococci has been noted among adults and children. The characteristic clinical and laboratory features of the streptococcal toxic shock syndrome include deep-seated infection associated with shock, skin manifestation, and multiorgan failure. However, bullous impetigo is invariably considered to be a staphylococcal disease.

Survey of the status of self-paid varicella vaccination among children one to six years of age in Taiwan.

Background And Purpose: Prior to 2004, the mass immunization program in Taiwan did not include varicella vaccine; however, parents could have their children vaccinated by the self-payment option.

Methods: In April 2002, we distributed 1271 questionnaires to the caregivers of children aged 1 to 6 years in Taoyuan county, Taiwan, to survey the status of vaccination rate against varicella, parental attitudes toward self-paid varicella vaccine, and the demographic characteristics of the family.

Results: Based on the answers provided in the questionnaires (99% response rate), we learned that until April 2002, the vaccination rate against varicella was 26%.

Tourette's syndrome with cervical disc herniation.

Tourette's syndrome is manifested in a broad spectrum of motor, vocal, and behavioral disturbances. Movement disorders, such as tics, may contribute to the development of cervical myelopathy owing to the effects of involuntary movements on the neck. However, the association of cervical myelopathy with motor tics of the head and neck is rare.

Significance of coagulase-negative staphylococci isolated from a single blood culture from neonates in intensive care.

Background: Coagulase-negative staphylococci (CoNS) are the most common pathogens of late-onset bacteraemia in neonatal intensive care units (NICUs). Discriminating true infection from contamination is difficult.

Methods: To evaluate the significance of a single blood culture yielding CoNS from only one blood culture obtained from NICU infants between July 1999 and November 2000, paired blood cultures were obtained simultaneously from two peripheral sites from infants hospitalised in two NICUs with clinically suspected late-onset sepsis, and a single blood culture was obtained peripherally from infants hospitalised in a third NICU.

Demonstration of tracheal bronchus associated with tracheal stenosis using direct coronal computed tomography.

A 2-year-old boy presented with chronic wheezes and was refractory to medical treatment. A high carina with bilateral bronchial stenosis was erroneously diagnosed by bronchoscopic examination. Serial direct coronal computed tomographic scans showed a displaced right upper lobe tracheal bronchus associated with tracheal stenosis below the abnormal bronchus.