Case Series of Midazolam-Induced Seizures-Like Activity in Five Neonates

An intravenous administration of midazolam may result in seizure-like activity or movement. This report describes five neonates who developed seizure-like movements after intravenous midazolam injection. The patients presented between 2019 and 2022. The abnormal movements occurred shortly after intravenous bolus administration of midazolam. None of our patients experienced seizure-like movements after receiving midazolam infusions. The seizure-like movements were aborted either spontaneously or by antiseizure medications. Also, we did not observe any seizure recurrence in any of the infants during the later stages of their treatment. Since this adverse effect might be related to the speed of the bolus administration, intravenous midazolam must be given as a slow bolus over 2-3 minutes followed by a slow flush of normal saline. To prevent midazolam's potential adverse effect on newborns, neonatal caregivers must be aware of it. Keywords: Midazolam; Injection, intravenous, Seizures; Infant, Newborn; Hypnotics and Sedatives

Ramsay Hunt Syndrome Associated with Varicella-Zoster Virus Encephalitis in a Child

Ramsay Hunt Syndrome (RHS) is a triad of peri-auricular pain, ipsilateral facial nerve palsy and vesicular rash around the ear pinna. It is caused by reactivation of varicella-zoster virus (VZV) that lies dormant in the geniculate ganglia. It can be complicated by VZV encephalitis rarely. We report the case of an 8-year-old previously healthy boy who presented to a tertiary care hospital in Muscat, Oman in 2021 with fever, progressive left ear pain, vesicular rash around his ear pinna and left-sided facial nerve palsy. His course was complicated by VZV encephalitis where he was managed with IV acyclovir and IV corticosteroids. He improved significantly and was asymptomatic with a normal neurology examination at the 6-months follow-up. Keywords: Varicella Zoster Virus; Ramsay Hunt Syndrome; Encephalitis; Children

Case report: Cyclosporine A-induced extrapyramidal syndrome following hematopoietic stem cell transplantation

IntroductionCyclosporine A-associated neurotoxicity has been reported in up to 40% of patients and its wide range of neurological adverse effects have been reported, ranging from mild tremors to fatal leukoencephalopathy. Extrapyramidal (EP) neurotoxicity is a rare manifestation of cyclosporine. Cyclosporine-induced extrapyramidal syndrome remains a rare adverse reaction.Design/methodsA database search was performed for studies in patients from all age groups. We found a total of 10 articles reporting EP as an adverse effect of cyclosporine A. A total of 16 patients were found, and a thorough review of these patients was performed. A comparison of patients was performed to highlight common clinical presentations, investigations during the symptomatic phase, and prognosis. In addition, we describe an 8-year-old boy who developed cyclosporine-related extrapyramidal signs on day 60 post-hematopoietic stem cell transplantation for beta-thalassemia.ConclusionCyclosporine A can induce neurotoxicity resulting in diverse symptoms. Signs of EP are rare manifestations of cyclosporine neurotoxicity and should be considered when evaluating post-transplant recipients of cyclosporine when they are present with any EP symptoms. Discontinuation of cyclosporine results in good recovery in most patients

Guillain-Barre Syndrome Associated with SARS-CoV-2 in Two Pediatric Patients

Guillain-Barre syndrome (GBS) is a recognized complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report two children with GBS associated with SARS-CoV-2 presented to a tertiary center in Muscat, Oman in 2021: The first patient was a 3-month-old female infant who presented with bradypnea, encephalopathy, and generalized weakness that required mechanical ventilation. Polymerase chain reaction (PCR) testing of the nasopharyngeal swabs (NPS) was positive for SARS-CoV-2. She had axonal variant GBS based on a nerve conduction study, cerebrospinal fluid analysis, and neuroimaging findings. The second patient was a 6-year-old girl with fever, vomiting, and diarrhea followed by ascending weakness who presented with quadriplegia and facial weakness. Subsequently, she developed respiratory muscle weakness and required mechanical ventilation. PCR testing of NPS was negative for SARS-Cov-2, however IgG serology analysis was positive. The clinical course of these two patients was rapidly progressive and both of them required mechanical ventilation. The patient with axonal variant GBS made an incomplete recovery. Keywords: Acute Inflammatory Demyelinating Polyradiculoneuropathy, SARS-CoV-2, Oma