Central nervous system anoxicischemic insult in children due to near-drowning
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Abstracts 497 peripheral blood count was done within two conclude that clinical outcome cannot be pre- hours of lumbar puncture. CSF samples with a dicted by initial CT scan alone, and state that positive bacteriologic culture and samples from such a diagnostic study appears to be unnec- patients with clinical aseptic meningitis were ex- essary in the evaluation of comatose patients cluded. For each CSF specimen, an expected with isolated near-drowning. [NJ Jouriles, MD] WBC count was calculated using the formula Editor’s Note: The authors illustrate the lack CSF WBC (expected)= CSF RBC x Blood WBC Blood RBC and was compared to the actual number of WBCs for each specimen. A strong correlation was found between expected and actual WBC counts in the CSF (r=0.6528). Actual WBC counts were approximately 20% of expected WBC counts. CSF samples from patients with documented subarachnoid hemorrhage were ana- lyzed in a similar fashion and found to have WBC counts 40% of expected. During the study three patients with positive CSF cultures and bloody taps were encountered. The actual WBC counts in these three CSF specimens were sub- stantially lower than the expected WBC. The authors conclude that CSF pleocytosis may be overlooked if traditional formulas for interpre- tation of traumatic CSF cell counts are used and suggest that patients with bloody CSF be fol- lowed closely for signs of meningitis. [Pamela M. Downey, MD] 0 CENTRAL NERVOUS SYSTEM ANOXIC- ISCHEMIC INSULT IN CHILDREN DUE TO NEAR-DROWNING. Taylor SB, Quencer RM, Holzman BH, Naidich TP. Radiology 1985; 156: 641-646. There are few reports outlining the role of computed tomography (CT) in evaluating neu- rologic injury following immersion incidents in children. In a retrospective review, the authors examined the records of 17 patients who under- went CT scanning of the head within 24 hours of admission for near-drowning. Two patients were alert on arrival and had normal CT scans. Both died, one following sudden neurologic de- terioration and one secondary to pulmonary complications. Fifteen patients were comatose on admission, ten of whom had normal CT scans. Three of these patients ultimately died, three had severe neurologic deficits, and four were neurologically normal at discharge. Of the five who had abnormal scans, four were eventually declared brain dead, and one was discharged with a normal neurologic exam. The authors of prognostic accuracy of CT in the setting of anoxic-ischemic injury secondary to near drown- ing. The possibility of head and neck trauma with potentially surgically correctable lesions must be kept in mind in all near-drowning vic- tims, however, and appropriate diagnostic stud- ies performed when indicated. 0 HERPES SIMPLEX VIRUS ENCEPHALI- TIS DURING CHILDHOOD: IMPORTANCE OF BRAIN BIOPSY DIAGNOSIS. Kohl S, James AR. J Pediatr 1985; 107:212-215. Brain biopsy was performed in 12 pediatric patients, age one day to eleven years, with sus- pected herpes simplex virus (HSV) encephalitis. Clinical diagnosis of HSV infection was based upon the presence of fever, altered mental status, cerebral spinal fluid (CSF) pleocytosis, and lo- calizing findings on neurologic examination. Five of the 12 patients were diagnosed as HSV en- cephalitis by brain biopsy; seven patients had other diagnoses including malignant glioma, sub- dural empyema, and enteroviral encephalitis. In the majority of patients with HSV infection, ill- ness began with such nonspecific symptoms as vomiting, loss of appetite, personality changes, lethargy, restlessness, and headache. The major signs of fever and seizures were seen in all pa- tients except one. Signs and symptoms did not permit clinical differentiation of patients with HSV encephalitis from those with other condi- tions. Routine laboratory tests such as complete blood count, electrolytes, and liver function tests were usually normal and generally not helpful in establishing the diagnosis. Electroencephalo- gram was more sensitive than computed tomog- raphy in identifying focal neurologic lesions ear- ly in the course of the illness. The mean time from hospitalization to the initiation of specific antiviral therapy was three days; therapy was usually begun 24 hours before biopsy in antici- pation of biopsy and definitive diagnosis. All patients with HSV infection did poorly. The au- thors note that since outcome of HSV encepha- litis is correlated with mental status at the time of onset of therapy, rapidity of diagnosis is par- amount. They recommend that children with sus-
Transcript of Central nervous system anoxicischemic insult in children due to near-drowning
Abstracts 497
peripheral blood count was done within two conclude that clinical outcome cannot be pre- hours of lumbar puncture. CSF samples with a dicted by initial CT scan alone, and state that positive bacteriologic culture and samples from such a diagnostic study appears to be unnec- patients with clinical aseptic meningitis were ex- essary in the evaluation of comatose patients cluded. For each CSF specimen, an expected with isolated near-drowning. [NJ Jouriles, MD]
WBC count was calculated using the formula Editor’s Note: The authors illustrate the lack
CSF WBC (expected) = CSF RBC x Blood WBC Blood RBC
and was compared to the actual number of WBCs for each specimen. A strong correlation was found between expected and actual WBC counts in the CSF (r=0.6528). Actual WBC counts were approximately 20% of expected WBC counts. CSF samples from patients with documented subarachnoid hemorrhage were ana- lyzed in a similar fashion and found to have WBC counts 40% of expected. During the study three patients with positive CSF cultures and bloody taps were encountered. The actual WBC counts in these three CSF specimens were sub- stantially lower than the expected WBC. The authors conclude that CSF pleocytosis may be overlooked if traditional formulas for interpre- tation of traumatic CSF cell counts are used and suggest that patients with bloody CSF be fol- lowed closely for signs of meningitis.
[Pamela M. Downey, MD]
0 CENTRAL NERVOUS SYSTEM ANOXIC- ISCHEMIC INSULT IN CHILDREN DUE TO NEAR-DROWNING. Taylor SB, Quencer RM, Holzman BH, Naidich TP. Radiology 1985; 156: 641-646.
There are few reports outlining the role of computed tomography (CT) in evaluating neu- rologic injury following immersion incidents in children. In a retrospective review, the authors examined the records of 17 patients who under- went CT scanning of the head within 24 hours of admission for near-drowning. Two patients were alert on arrival and had normal CT scans. Both died, one following sudden neurologic de- terioration and one secondary to pulmonary complications. Fifteen patients were comatose on admission, ten of whom had normal CT scans. Three of these patients ultimately died, three had severe neurologic deficits, and four were neurologically normal at discharge. Of the five who had abnormal scans, four were eventually declared brain dead, and one was discharged with a normal neurologic exam. The authors
of prognostic accuracy of CT in the setting of anoxic-ischemic injury secondary to near drown- ing. The possibility of head and neck trauma with potentially surgically correctable lesions must be kept in mind in all near-drowning vic- tims, however, and appropriate diagnostic stud- ies performed when indicated.
0 HERPES SIMPLEX VIRUS ENCEPHALI- TIS DURING CHILDHOOD: IMPORTANCE OF BRAIN BIOPSY DIAGNOSIS. Kohl S, James AR. J Pediatr 1985; 107:212-215.
Brain biopsy was performed in 12 pediatric patients, age one day to eleven years, with sus- pected herpes simplex virus (HSV) encephalitis. Clinical diagnosis of HSV infection was based upon the presence of fever, altered mental status, cerebral spinal fluid (CSF) pleocytosis, and lo- calizing findings on neurologic examination. Five of the 12 patients were diagnosed as HSV en- cephalitis by brain biopsy; seven patients had other diagnoses including malignant glioma, sub- dural empyema, and enteroviral encephalitis. In the majority of patients with HSV infection, ill- ness began with such nonspecific symptoms as vomiting, loss of appetite, personality changes, lethargy, restlessness, and headache. The major signs of fever and seizures were seen in all pa- tients except one. Signs and symptoms did not permit clinical differentiation of patients with HSV encephalitis from those with other condi- tions. Routine laboratory tests such as complete blood count, electrolytes, and liver function tests were usually normal and generally not helpful in establishing the diagnosis. Electroencephalo- gram was more sensitive than computed tomog- raphy in identifying focal neurologic lesions ear- ly in the course of the illness. The mean time from hospitalization to the initiation of specific antiviral therapy was three days; therapy was usually begun 24 hours before biopsy in antici- pation of biopsy and definitive diagnosis. All patients with HSV infection did poorly. The au- thors note that since outcome of HSV encepha- litis is correlated with mental status at the time of onset of therapy, rapidity of diagnosis is par- amount. They recommend that children with sus-
