Pediatric ischemic stroke – an unlikely diagnosis: a report of three cases

Pediatric ischemic stroke is a rare and devastating disease. A patient presenting with acute neurological deficit should raise suspicion of a possible stroke. However, stroke “mimics” account for a majority of suspected stroke cases in childhood. We present three cases of pediatric acute ischemic stroke, two of which are arterial, and one caused by thrombosis of venous sinuses. In the first case, we present a 16-year old male patient was admitted to our hospital due to a rare Artery of Percheron occlusion. The second case represents a 17-year old female patient with thrombosis of multiple cerebral venous sinuses, venous infarctions and secondary hemorrhages. As the third case, we present 6-year old male patient with a herpes simplex infection and a vertebrobasilar stroke. All three patients had experienced an altered mental status and other nonspecific symptoms. Due to its rarity, diverse clinical presentation, and lack of randomized control trials regarding treatment, ischemic stroke poses a great challenge to pediatricians

Characteristics of the Manifestation of Multiple Sclerosis in Children in Lithuania

Background and Objectives: Multiple sclerosis (MS) starts quite rarely in childhood, comprising just 3–10% of all diagnosed cases of MS population. The age of onset of the disease may be related to the initial phenotype and the prognosis of MS. The aim of the study is to assess the characteristics of the manifestation of MS in children. Materials and Methods: Two groups of patients were analyzed: those diagnosed with MS in childhood (0 Results: For the analysis, 105 patients were selected: 35 children (group A) and 70 adults (group B). At the onset of the disease, 62.9% of children and 70.0% of adults experienced visual disturbances (p > 0.05). Isolated symptoms were more common in children (65.7%) as compared to adults (28.6%), p p p p p p = 0.007). Conclusions: The initial symptoms of multiple sclerosis in pediatric patients usually appeared around the age of 16, with a similar frequency in boys and girls, and in most of the childhood cases the initial symptoms were limited to the dysfunction of a single part of the nervous system children usually started with visual disorders, while sensory, coordination and motor disorders were less common. The course of the disease in juvenile patients with MS was more aggressive in the first year as there were more relapses, but the functional impairment recovered faster as compared to adults

Executive Functions in Adolescents With Idiopathic Generalized Epilepsy

Disorders of executive functioning have recently been reported in patients with juvenile myoclonic epilepsy (JME); however, data on other syndromes of generalized idiopathic epilepsy (IGE) other than JME, especially in adolescence, are scarce. The aim of this study was to explore specific executive functions in a group of adolescents with IGE of short duration and to evaluate the possible factors that might influence these functions. Material and Methods. Neuropsychological investigation of executive functions (the Verbal Fluency Test, the Five-Point Test, the Trail-Making Test, and the Stroop test) was performed in 59 patients aged 14–17 years and meeting the diagnostic criteria for IGE, and in the group of 59 agematched controls without any history of epilepsy. Results. The IGE group subjects scored worse than the controls in most of the executive function tests: phonemic (P=0.008) and semantic (P=0.001) word fluency, figural fluency (P=0.008), visual search and sequencing of numbers (P=0.001), and alternate number-letter sequencing (P=0.018). None of the test scores differed between the new-onset and the established IGE groups, or between the groups of cases with and without myoclonias. No relationship between executive functioning and gender, age, duration or activity of epilepsy, treatment, or epileptiform discharges on electroencephalography was found. Conclusions. Executive dysfunction was present in adolescents with JME and other syndromes of IGE, manifesting with generalized tonic-clonic seizures without myoclonias, despite short duration and benign course of epileps

Paauglių, sergančių idiopatine generalizuota epilepsija, pažinimo funkcijos

Disorders of executive functioning have recently been reported in patients with juvenile myoclonic epilepsy (JME); however, data on other syndromes of generalized idiopathic epilepsy (IGE) other than JME, especially in adolescence, are scarce. The aim of this study was to explore specific executive functions in a group of adolescents with IGE of short duration and to evaluate the possible factors that might influence these functions. Material and Methods. Neuropsychological investigation of executive functions (the Verbal Fluency Test, the Five-Point Test, the Trail-Making Test, and the Stroop test) was performed in 59 patients aged 14–17 years and meeting the diagnostic criteria for IGE, and in the group of 59 agematched controls without any history of epilepsy. Results. The IGE group subjects scored worse than the controls in most of the executive function tests: phonemic (P=0.008) and semantic (P=0.001) word fluency, figural fluency (P=0.008), visual search and sequencing of numbers (P=0.001), and alternate number-letter sequencing (P=0.018). None of the test scores differed between the new-onset and the established IGE groups, or between the groups of cases with and without myoclonias. No relationship between executive functioning and gender, age, duration or activity of epilepsy, chronic use of treatment, or epileptiform discharges on electroencephalography was found. Conclusions. Executive dysfunction was present in adolescents with JME and other syndromes of IGE, manifesting with generalized tonic-clonic seizures without myoclonias, despite short duration and benign course of epilepsy

Psychosocial adjustment difficulties among hospitalized adolescents with neurological and physical disorders

Sveikatos sutrikimų turinčių paauglių psichologinė ir socialinė adaptacija tyrinėjama plačiai, tačiau neaišku ar nevienodo pobūdžio sutrikimai adaptaciją paveikia skirtingai (t. y. pasižymi specifine įtaka), ar pats sveikatos sutrikimas (nepriklausomai nuo jo pobūdžio), kaip paauglio aktyvumą ir socialinį gyvenimą ribojantis veiksnys, susijęs su blogesne psichologine ir socialine adaptacija. Darbo tikslas. Ištirti paauglių, gydomų nuo somatinių ir neurologinių ligų, bei sveikų paauglių psichologinės ir socialinės adaptacijos sunkumų ypatybes. Tyrime dalyvavo 100 sergančiųjų neurologinėmis ir 94 somatinėmis ligomis 12–18 metų paauglių, gydomų stacionare, o lyginamąją grupę sudarė 544 to paties amžiaus bendrojo lavinimo mokyklų mokiniai. Paauglių psichologinės ir socialinės adaptacijos sunkumų paplitimui įvertinti naudotas standartizuotas interviu paauglių problemoms įvertinti. Nustatyta, kad tiek sergančiųjų somatinėmis, tiek neurologinėmis ligomis paauglių grupėse nuotaikos, emociniai ir savęs vertinimo sunkumai labiau paplitę ir didesnio laipsnio nei sveikų bendraamžių grupėje, o sveikų paauglių grupėje labiau paplitę ir didesnio laipsnio konfliktai su aplinkiniais. Tuo tarpu psichologinės ir socialinės adaptacijos skirtumai tarp abiejų klinikinių paauglių grupių nėra tokie akivaizdūs. Paaiškėjo, kad neurologinės ligos susijusios su didesniu emocinių ir kognityvinio funkcionavimo sunkumų paplitimu ir didesniu polinkiu į savižudybę, o somatinės – su didesniu sunkumų, kylančių dėl paauglių elgesio, paplitimuPsychosocial adjustment of adolescents with health disorders has been studied extensively. However, it is unclear whether different health disorders have specific impact on adjustment, or disorder in general relates to the development of adjustment difficulties as a factor limiting adolescent’s physical and social activity. This study was aimed to identify peculiarities of psychosocial adjustment difficulties among hospitalized adolescents with neurological and physical disorders and secondary school students. The sample consisted of 738 adolescents (aged 12–18 years), of which 100 had neurological and 94 – physical disorders, and 544 secondary school students. Psychosocial adjustment difficulties were evaluated using Standardized Interview for the Evaluation of Adolescents’ Problems. Results show that emotional-mood difficulties and low self-esteem are more prevalent and severe in the clinical groups comparing with the healthy controls, while the prevalence and the severity of conflicts are higher among students. Comparison of both clinical groups shows that neurological disorders are related to higher prevalence of difficulties in emotional and cognitive functioning and higher severity of suicidal tendencies, while physical disorders relate to higher prevalence of behavior difficultiesAbromiškių reabilitacijos ligoninėKauno medicinos universitetasVytauto Didžiojo universiteta