Delayed onset acute hemiparesis in Japanese Encephalitis: A case report and literature review (อาการแขนขาซีกซ้ายอ่อนแรงเฉียบพลันที่เกิดตามหลังโรคไข้สมองอักเสบเจอี: รายงานผู้ป่วย 1 ราย)

Japanese encephalitis remains an important public health burden in Thailand despite japanese encephalitis vaccine has been employed in the Expanded Program of Immunization (EPI). Acute stroke or hemiparesis was an atypical feature in japanese encephalitis. We report a case of japanese encephalitis proven by demonstration of specific IgM antibody against JEV in serum with delayed presentation of left hemiparesis. No remarkably structural abnormality of brain parenchyma was detected by computer tomography (CT) and magnetic resonance imaging (MRI). With supportive treatment and physical rehabilitation, this patient has returned to fully normal neurological function

Intrapulmonary vascular dilation in children with chronic liver diseases: pre- and post-liver transplantation

Background and study aims. Chronic liver disease (CLD) can cause hepatopulmonary syndrome (HPS), defined as triad of liver disease, hypoxemia, and intrapulmonary vascular dilation (IPVD). The aim of this study was to determine the evidence of IPVD in a cohort of pediatric patients with CLD pre- and post-liver transplantation (LT).Material and methods. All pediatric patients with CLD listed for LT were studied. Pulse oxygen saturation (SpO2), technetium-99m-labeled macroaggregated albumin (99mTc- MAA) perfusion scan (positive test: uptake of the isotope ≥ 6% in the brain), and echocardiography with saline bubble test (SBT) were performed. SBT was re-evaluated at 3-6 months after LT. Grading of SBT included grade 0 (no bubble), I (1-9 bubbles), grade II (10-20 bubbles), and grade III (> 20 bubbles).Results. Eighteen patients, median age 22.5 months (8-108), were enrolled. Most had biliary atresia (77.8%). Pre-LT, all patients had SpO2 of 100% and none had positive 99mTc- MAA perfusion scan. Two patients (11%) had negative SBT (grade 0), 1 (5.5%) had grade I, 3 (16.5%) had grade II, and 12 (67%) had grade III, respectively. Post-LT SBT became negative in all survivors (n = 16), (p = 0.0001).Conclusions. Most cirrhotic children in this cohort study had evidence of IPVD by positive SBT. However, none of these met the criteria for diagnosis of HPS. This evidence of IPVD subsided after LT