Evaluation of immunization status in patients with cerebral palsy: a multicenter CP-VACC study

Children with chronic neurological diseases, including cerebral palsy (CP), are especially susceptible to vaccine-preventable infections and face an increased risk of severe respiratory infections and decompensation of their disease. This study aims to examine age-appropriate immunization status and related factors in the CP population of our country. This cross-sectional prospective multicentered survey study included 18 pediatric neurology clinics around Turkey, wherein outpatient children with CP were included in the study. Data on patient and CP characteristics, concomitant disorders, vaccination status included in the National Immunization Program (NIP), administration, and influenza vaccine recommendation were collected at a single visit. A total of 1194 patients were enrolled. Regarding immunization records, the most frequently administrated and schedule completed vaccines were BCG (90.8%), hepatitis B (88.9%), and oral poliovirus vaccine (88.5%). MMR was administered to 77.3%, and DTaP-IPV-HiB was administered to 60.5% of patients. For the pneumococcal vaccines, 54.1% of children received PCV in the scope of the NIP, and 15.2% of children were not fully vaccinated for their age. The influenza vaccine was administered only to 3.4% of the patients at any time and was never recommended to 1122 parents (93.9%). In the patients with severe (grades 4 and 5) motor dysfunction, the frequency of incomplete/none vaccination of hepatitis B, BCG, DTaP-IPV-HiB, OPV, and MMR was statistically more common than mild to moderate (grades 1-3) motor dysfunction (p = 0.003, p < 0.001, p < 0.001, p < 0.00, and p < 0.001, respectively). Physicians' influenza vaccine recommendation was higher in the severe motor dysfunction group, and the difference was statistically significant (p = 0.029). Conclusion: Children with CP had lower immunization rates and incomplete immunization programs. Clinicians must ensure children with CP receive the same preventative health measures as healthy children, including vaccines

Clinical Characteristics and Visual Outcomes of Pediatric Optic Neuritis: A Single Center Experience

INTRODUCTION: The aim of this study was to describe the clinical characteristics, visual outcomes of pediatric patients presenting with first-episode of optic neuritis. METHODS: We reviewed medical records of the patients newly diagnosed with optic neuritis younger than 18 years between January 2014 and December 2018 retrospectively. RESULTS: Twenty-eight patients were included to this study. The mean age at first onset of optic neuritis was 13.2+-3.1 years (range 6.2-17.3 years). The mean follow-up period was 4.2+-3.2 (range 0.6-13.08) years. 7 of 28 (25%) patients had recurrent optic neuritis. Optic neuritis involvement was unilateral in 17 of 28 (60%) patients. Forty percent of the patients had idiopathic optic neuritis. Of the six patients with demyelinating lesions in cranial magnetic resonance imaging (MRI) at the first admission, three were diagnosed with multiple sclerosis (MS) at the time of first optic neuritis attack, and three were diagnosed within 13.4+-4.8 months after the first episode. Eight of 21 optic neuritis patients (38%) had oligoclonal band positivity and the incidence of MS was significantly higher in these patients (p=0.014). The mean visual acuity at nadir was 0.48+-0.27 at admission. Whereas it was 0.74+-0.31 and 0.76+-0.33 at 1 and 6 months respectively. There was a strong correlation between first and sixth-month visual acuity (r=0.98, p=0.00). DISCUSSION AND CONCLUSION: Our study demonstrated that poor visual acuity (worse than 0.5) at 1 month can predict poor vision at 6 months. The patients with demyelinating lesions in cranial MRI at their first optic neuritis episode, are more likely to develop MS during the follow-up

Detection rate of aneurysms and subarachnoid hemorrhage in patients who underwent cranial CT angiography due to severe headache

Amaç: Çalışmamızın amacı şiddetli baş ağrısı nedeniyle acil servise başvuran ve kranial BT anjiyografi (BTA) çekilen hastalarda anevrizma ve subaraknoid kanama (SAK) saptanma oranının ve bunların birbiriyle olan ilişkisinin değerlendirilmesidir.Yöntemler: Bu çalışmada Ocak 2012-Ağustos 2014 tarihleri arasında şiddetli baş ağrısıyla acil servise başvuran, SAK ve anevrizma ön tanısıyla BTA çekilen 142'si erkek, 147'si kadın olmak üzere toplam 289 hasta retrospektif olarak değerlendirilmiştir . Önce kontrastsız seriler SAK varlığı açısından incelenmiştir. Daha sonra anjiyografi görüntüleri anevrizma varlığına yönelik olarak değerlendirilmiştir. Olgular anevrizma varlığına dayanarak sınıflanmıştır (anevrizma var/yok şeklinde). Anjiyografi görüntülerinin değerlendirilmesinde aksiyal kaynak görüntülere ek olarak maksimum intensite projeksiyon ve 3 boyutlu reformat imajlar kullanılmıştır. Kontrastsız BT'nin SAK varlığına dayanarak anevrizma varlığını öngörmedeki duyarlılığı, özgüllüğü, pozitif öngörü değeri ve negatif öngörü değeri ki-kare testi kullanılarak hesaplanmıştır. Anevrizma varlığı ile SAK arasındaki korelasyonu saptamak için kappa analizi yapılmıştır.Bulgular: Şiddetli baş ağrısı nedeniyle BTA çekilen 289 hastanın 132'sinde anevrizma saptanmış olup, geri kalan 157'sinde anevrizma izlenmemiştir. Kontrastsız seriler değerlendirildiğinde; 142 hastada SAK mevcut olup, bu hastaların 81'inde anevrizma izlenirken, 61'inde anevrizma saptanmamıştır. Buna karşın 147 hastada SAK mevcut olmayıp, bu hastaların da 51'inde anevrizma izlenirken, 96'sında anevrizma saptanmamıştır. Bu verilerle kontrastsız BT'nin SAK varlığına dayanarak anevrizma varlığını öngörmedeki duyarlılığı %61, özgüllüğü %61, pozitif öngörü değeri %57 ve negatif öngörü değeri %65 bulunmuştur. Ayrıca kappa testinde anevrizma varlığı ile SAK arasında zayıf korelasyon saptanmıştır.Sonuç: Şiddetli baş ağrısı kliniği ile acil servise başvuran olgularda en çok kullanılan radyolojik tetkik kontrastsız BT incelemedir. Ancak, kontrastsız serilerde SAK saptanmaması rüptüre anevrizma tanısından uzaklaştırsa da anevrizma varlığını dışlamamaktadır. Öte yandan BTA'nın her türlü nedenden kaynaklanabilecek hafif ve non-spesifik baş ağrısı durumlarında tarama tetkiki olarak kullanılması uygun değildir. Tanısal algoritmde en doğru yaklaşım hastanın kliniğini en önemli unsur olarak kabul ederek uygun basamakları izlemektirObjective: The purpose of our study is to evaluate rate of aneurysms and subarachnoid hemorrhage (SAH) detected in cranial computed tomography angiography (CTA) in patients who applied to the emergency service with severe headache and to determine relationship between SAH and aneurysm. Methods: In this study total of 289 patients (142 male, 147 female, median age 51.8, range 18-87) who had undergone CTA due to headache were evaluated. Firstly, non-contrast series were evaluted for the presence of SAH. Later, angiographic images were evaluted for the presence of aneurysm. In the evaluation of angiograms, in addition to axial images, maximum intensity projection , and 3D reformate images were used. Sensitivity, specificity, positive and negative predictive values related to non-enhanced CT in order to estimate the presence of aneurysm depending on the presence of SAH were calculated with chi-square test. Additionally, with kappa analysis the correlation between the presence of SAH and aneurysm was evaluated. Results: Among 289 patients who had undergone CTA due to severe headache, aneurysms were detected in 132 patients, while no aneurysm was found in 157 patients. Concerning the non-enhanced series, SAH was detected in 142 patients and in 81 patients among them, aneurysms were detected, while no aneurysm was found in the remaining 61 patients. On the other hand, among 147 patients without SAH, 51 patients had aneurysm, whereas in 96 of them no aneurysm was found. According to these findings, the sensitivity, specificity, positive and negative predictive values of CT to estimate presence of aneurysm depending on presence of SAH were calculated as 61%, 61%, 57% and 65%, respectively. Also, kappa analysis revealed weaker correlations between presence of SAH and aneurysm. Conclusion: Absence of SAH in non-enhanced CT makes the diagnosis of ruptured aneurysm less probable, and it doesn't rule out presence of aneurysm. On the other hand, use of CTA for every kind of mild, and nonspecific headache which may originate from any cause, isn't appropriate. The best approach in diagnostic algorithm is to follow appropriate steps considering clinical symptoms of the patients as the most important determinative factor