Optic Nerve Sheath Diameter Measurement in Children Presenting to a Pediatric Emergency Department with Head Trauma

Introduction:Optic nerve sheath diameter (ONSD) measurement is a non-invasive and easy imaging technique for the estimation of intracranial pressure in children and adults. We aimed to measure the ONSD in pediatric patients with head trauma.Methods:In this study, 40 patients with head trauma and age- and sex-matched 40 healthy children were included. Nerve sheath diameter was measured by transorbital sonography.Results:Diameter of the mean optic nerve sheath of the right and left eye of the patients were 0.408±0.064 mm and 0.417±0.065 mm, respectively; both results were higher in patients than in controls. In the right eyes of the patients, the ONSD values had a negative correlation with Glasgow Coma Scale scores. There was a positive correlation between systolic and diastolic blood pressures and optic nerve sheath diameters of patients. Clinical status of the patients at admission and blood pH levels were associated with ONSD.Conclusion:The result of our study indicated that ONSD measurement is a non-invasive technique and can be used easily to estimate increased intracranial pressure in pediatric emergency departments

The evaluation of vitamin K status in children with febrile seizure

Background: Febrile seizure is the most common neurological disorder in childhood. The exact pathophysiology of febrile seizures is unknown. Recent studies showed the role of vitamin K in nonhematological and inflammatory disorders. This study aimed to investigate the serum vitamin K levels in children with febrile seizures. Aims: To evaluate vitamin K levels in children with febrile seizures. Study Design: Prospective case-control study. Methods: This multicenter study examined representative populations in 8 different cities in Turkey between April 1, 2018 and April 1, 2019. Blood samples were taken from all children at presentation. Vitamin K1, vitamin K2, tumor necrosis factor-alpha, interleukin 1 beta, and interleukin 6 levels were determined by enzyme-linked immunosorbent assay. Results: A total of 155 children were included in the study—84 children with febrile seizures and 71 children in febrile control group. Serum vitamin K1 and vitamin K2 levels were also higher in children with febrile seizures than in the controls. The results of statistical analysis showed that vitamin K1 and vitamin K2 levels were correlated with tumor necrosis factor-alpha, interleukin 1 beta, and interleukin 6 levels. The median vitamin K1 and vitamin K2 levels of children experiencing their first febrile seizure were higher than those in children with recurrent febrile seizures. Type of febrile seizure has no effect on serum vitamin K1 and vitamin K2 levels. Conclusion: In children with febrile seizures, vitamin K levels are higher than those in the control group. These new findings may contribute to elucidating the etiopathogenesis of febrile seizures

Acute flaccid myelitis outbreak through 2016-2018: A multicenter experience from Turkey

Aim: We aim to describe the demographic characteristics, etiology, neurophysiology, imaging findings, treatment, prognosis, and prognostic factors of acute flaccid myelitis. Methods: The clinical data, laboratory test and, magnetic resonance imaging (MRI) results of pediatric patients diagnosed with acute flaccid myelitis according to the Centers for Disease Control criteria between August 1, 2016, and December 31, 2018, from 13 centers in Turkey were reviewed. Results: Of the 34 cases identified, 31 were confirmed (91.2%). Eighteen patients (55.9%) were boys. The median patient age was 4 years (interquartile range 2.5–6.9 years). Most of the patients were admitted in 2018 (n = 27). A preceding history of a febrile illness was reported in all patients, with a median of 4 days (interquartile range 3–7 days) before symptom onset. Thirty-one patients had T2 hyperintensity on spinal MRI, and 18 patients had cerebrospinal fluid pleocytosis. The most common infectious agents were entero/rhinoviruses (n = 5) in respiratory specimens. All patients except one received immunotherapy either alone or in combination. Among 27 patients with follow-up data 24 had persistent weakness. Involvement of four limbs together with an abnormal brain MRI at onset were associated with a poor prognosis. Conclusion: The number of patients with acute flaccid myelitis increased since 2012, spiking with every 2-year interval, largely in the pediatric population. The median age decreases with every outbreak. Clinicians should be aware of the clinical picture for early collection of specimens and early start of rehabilitation programs. Further studies are needed to better characterize the etiology, pathogenesis, risk factors, and treatment of this rare condition