PubMed · 14054712
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D EGGIS. 1963-08-31. [EVOLUTIONARY PERSPECTIVES ON POSTTRAUMATIC ENCEPHALOPATHY].. https://pubmed.ncbi.nlm.nih.gov/14054712/
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Central nervous system (CNS) vasculitis secondary to chronic parvovirus B19 (B19) infection presenting with recurrent neurological findings is a very rare disorder during childhood. Here we report a 12-year-old boy with a renal transplant who had chronic B19 infection with skin eruptions and recurrent episodes of encephalopathy with focal neurological deficits. B19 DNA was detected in blood, bone marrow, and skin biopsy specimens. Repeat cranial magnetic resonance (MR) imaging during each episode of encephalopathy showed variable focal findings, and MR angiography revealed vasculitic changes with narrowing of the cerebral arteries. We hypothesized that the CNS vasculitis might be associated with the chronic B19 infection. At the time of his fourth presentation with the same clinical findings, we administered intravenous immunoglobulin (IVIG) (1 g/kg per day, 2 consecutive days), which we continued for 6 months, at monthly intervals. IVIG therapy resulted in remission and has been effective not only for the clearance of B19, but also for the improvement of clinical and radiological findings of CNS vasculitis. We suggest that chronic B19 infection should be considered in immunocompromised patients with suspected CNS vasculitis. IVIG should be considered as a part of the treatment.
INTRODUCTION: Hemispherectomy constitutes an established surgical method in the management of patients with medically intractable epilepsy, secondary to severe unilateral hemisphere damage. The well-established association of the anatomical hemispherectomy initially described with severe complications such as late hydrocephalus has led to the development of less resective and more disconnecting procedures. All these technical variations of hemispherotomy carry less favorable outcomes compared with anatomic hemispherectomy, but significantly fewer complications. METHODS: In our current communication, we outline the indications and the surgical technique of hemispherotomy and report our experience of the clinical application of this surgical procedure. RESULTS: In our clinical series, the 5-year follow-up shows that 66.6% of our patients (6 out of 9) had class I outcome according to Engel's classification system, 22.2% (2 out of 9) class II outcome, while 11.1% (1 out of 9) had class III outcome. No mortality occurred in the current series and operative blood loss was significantly lowered. CONCLUSION: Hemispherotomy represents a less efficacious technique compared with anatomic hemispherectomy, but is a safe and technically simple surgical alternative for the management of patients with medically intractable seizures.