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e3 85 Muzumdar D, Jhawar S, Goel A Brain abscess: an overview Int J Surg 2011;9:136-144 86 Frazier JL, Ahn ES, Jallo GI Management of brain abscesses in children Neurosurg Focus 2008;24:E8 87 Kao P-T, Tseng H-S, Liu C-P, et al., Brain abscess: clinical analysis of 53 cases J Microbiol Immunol Infect 2003;36:129-136 88 Goodkin HP, Harper MB, Pomeroy SL Intracerebral abscess in children: historical trends at Children’s Hospital Boston Pediatrics 2004;113:1765-1770 89 Nathoo N, Nadvi SS, Narotam PK, van Dellen JR Brain abscess: management and outcome analysis of a computed tomography era experience with 973 patients World Neurosurg 2011;75:716-726 90 Saez-Llorens X Brain abscess in children Semin Pediatr Infect Dis 2003;14:108-114 91 Bonfield CM, Sharma J, Dobson S Pediatric intracranial abscesses J Infect 2015;71:s42-s46 92 Mathisen GE, Johnson JP Brain abscess Clin Infect Dis 1997;25:763-781 93 Xiao F, Tseng MY, Teng LJ, et al Brain abscess: clinical experience and analysis of prognostic factors Surg Neurol 2005;63:442-450 94 Goodkin HP, Harper MB, Pomeroy SL Intracerebral abscess in children: historical trends at Children’s Hospital Boston Pediatrics 2004;113:1765-1770 95 Tekkök IH, Erbengi A Management of brain abscess in children: review of 130 cases over a period of 21 years Childs Nerv Syst 1992;8:411-416 96 Wong TT, Lee LS, Wang HS, et al Brain abscesses in children-a cooperative study of 83 cases Childs Nerv Syst 1989;5:19-24 97 de Oliveira RS, Pinho VF, Madureira JF, Machado HR Brain abscess in a neonate: an unusual presentation Childs Nerv Syst 2007; 23:139-142 98 Brouwer MC, Tunkel AR, McKhann GM, et al Brain abscess N Engl J Med 2014;31:447-456 99 Foerster BR, Thurnher MM, Malani PN, et al Intracranial infections: clinical and imaging characteristics Acta Radiol 2007;48: 875-893 100 Carpenter J, Stapleton S, Holliman R Retrospective analysis of 49 cases of brain abscess and review of the literature Eur J Clin Microbiol Infect Dis 2007;l26:1-11 101 Yogev R, Bar-Meir M Management of brain abscesses in children Pediatric Infect Dis J 2004;23:157-159 102 Reddy JS, Mishra AM, Behari S, et al The role of diffusionweighted imaging in the differential diagnosis of intracranial cystic mass lesions: a report of 147 lesions Surg Neurol 2006;66:246-250 103 Sheehan JP, Jane JA, Ray DK, et al Brain abscess in children Neurosurg Focus 2008;24:E6 104 Xu XX, Li B, Yang HF, et al Can diffusion-weighted imaging be used to differentiate brain abscess from other ring-enhancing brain lesions? A metaanalysis Clin Radiol 2014;69:909-915 105 Brook I Microbiology and the treatment of brain abscesses J Clin Neurosci 2017;38:8-12 106 Brouwer MC, van de Beek D Epidemiology, diagnosis and treatment of brain abscesses Curr Opin Infect Dis 2017;30:129-134 107 Bernardini GL Diagnosis and management of brain abscess and subdural empyema Curr Neurol Neurosci Rep 2004;4:448-456 108 Agarwal D, Suri A, Mahapatra AK Primary excision of pediatric posterior fossa abscesses – towards zero mortality? 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84(1005):e179-e181 129 Teoh HL, Mohammad SS, Britton PN, et al Clinical characteristics and functional motor outcomes of enterovirus 71 neurological disease in children JAMA Neurol 2016;73(3):300-307 130 Zeng H, Huang W, Wen F, et al MRI signal intensity differentiation of brainstem encephalitis induced by Enterovirus 71: a classification approach for acute and convalescence stages Biomed Eng Online 2016;15:25 131 Bale Jr JF Virus and immune-mediated encephalitides: epidemiology, diagnosis, treatment, and prevention Pediatr Neurol 2015; 53(1):3-12 132 Jones G, Muriello M, Patel A, Logan L Enteroviral meningoencephalitis complicated by central diabetes insipidus in a neonate: a case report and review of the literature J Pediatric Infect Dis Soc 2015;4(2):155-158 133 Cruz AT, Freedman SB, Kulik DM, et al; and the HSV Study Group of the Pediatric Emergency Medicine Collaborative Research Committee Herpes simplex virus infection in infants undergoing meningitis evaluation Pediatrics 2018;141(2):e20171688 e4 134 Rudolph H, Schroten H, Tenenbaum T Enterovirus infections of the central nervous system in children: an update Pediatr Infect Dis J 2016;35(5):567-569 135 World Health Organization Hand, Foot and Mouth Disease https:// www.who.int/westernpacific/emergencies/surveillance/archives/ hand-foot-and-mouth-disease 136 Renaud C, Harrison CJ Human parechovirus 3: the most common viral cause of meningoencephalitis in young infants Infect Dis Clin North Am 2015;29(3):415-428 137 Venkatesan A, Murphy OC Viral encephalitis Neurol Clin 2018; 36(4):705-724 138 Sejvar JJ Clinical manifestations and outcomes of West Nile virus infection Viruses 2014;6(2):606-623 139 Gaensbauer JT, Lindsey NP, Messacar K, Staples JE, Fischer M Neuroinvasive arboviral disease in the United States: 2003 to 2012 Pediatrics 2014;134(3):e642-e650 140 Lindsey NP, Porse CC, Potts E, et al Zika Virus Disease Enhanced Surveillance Working Group Postnatally acquired Zika virus disease among children, United States, 2016-2017 Clin Infect Dis 2019; Pii: ciz195 141 C Lage ML, Carvalho AL, Ventura PA, et al Clinical, neuroimaging, and neurophysiological findings in children with microcephaly related to congenital Zika virus infection Int J Environ Res Public Health 2019;16(3):E309 142 Centers for Disease Control and Prevention Rabies https://www cdc.gov/rabies/index.html 143 Bonthius DJ Lymphocytic choriomeningitis virus: an underrecognized cause of neurologic disease in the fetus, child, and adult Semin Pediatr Neurol 2012;19(3):89-95 144 Paksu MS, Aslan K, Kendirli T, et al Neuroinfluenza: evaluation of seasonal influenza associated severe neurological complications in children (a multicenter study) Childs Nerv Syst 2018;34(2):335-347 145 Okuno H, Yahata Y, Tanaka-Taya K, et al Characteristics and outcomes of influenza-associated encephalopathy cases among children and adults in Japan, 2010-2015 Clin Infect Dis 2018; 66(12):1831-1837 146 Britton PN, Blyth CC, Macartney K, et al, and the Australian Childhood Encephalitis (ACE) Study Investigators, Influenza Complications Alert Network (FluCAN) Investigators, and Paediatric Active Enhanced Disease Surveillance (PAEDS) Network The spectrum and burden of influenza-associated neurological disease in children: combined encephalitis and influenza sentinel site surveillance from Australia, 2013-2015 Clin Infect Dis 2017;65(4):653-660 147 Remy KE, Custer JW, Cappell J, et al Pediatric anti-N-methyl-daspartate receptor encephalitis: a review with pooled analysis and critical care emphasis Front Pediatr 2017;5:250 148 Peery HE, Day GS, Doja A, et al Anti-NMDA receptor encephalitis in children: the disorder, its diagnosis, and treatment Handb Clin Neurol 2013;112:1229-1233 149 Florance-Ryan N, Dalmau J Update on anti-N-methyl-D-aspartate receptor encephalitis in children and adolescents Curr Opin Pediatr 2010;22:739-744 150 Chen W, Su Y, Jiang M, et al Status epilepticus associated with acute encephalitis: long-term follow-up of functional and cognitive outcomes in 72 patients Eur J Neurol 2018;25:1228-1234 151 Venkatesan A Epidemiology and outcomes of acute encephalitis Curr Opin Neurol 2015;28:277-282 152 Kumar, R, Singhi S, Singhi P, et al Randomized controlled trial comparing cerebral perfusion pressure-targeted therapy versus intracranial pressure-targeted therapy for raised intracranial pressure due to acute CNS infections in children Crit Care Med 2014;42:1775-1787 153 Safain MG, Roguski M, Kryzanski JT, Weller SJ A review of the combined medical and surgical management in patients with herpes simplex encephalitis Clin Neurol Neurosurg 2015;128:10-16 154 Kimberlin DW, Brady MT, Jackson MA, Long SS Red Book: 20182021 Report of the Committee on Infectious Diseases Itasca, IL: American Academy of Pediatrics; 2018 155 Reed Z, Cardosa MJ Status of research and development of vaccines for enterovirus 71 Vaccine 2016;34(26):2967-2970 156 Rao S, Elkon B, Flett KB, et al Long-term outcomes and risk factors associated with acute encephalitis in children J Pediatric Infect Dis Soc 2017;6(1):20-27 157 Menge T, Kieseier BC, Nessler S, et al Acute disseminated encephalomyelitis: an acute hit against the brain Curr Opin Neurol 2007;20:247-254 158 Krupp LB, Tardieu M, Amato MP, et al International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions Mult Scler 2013; 19:1261-1267 159 Pohl D, Alper G, Van Haren K, et al Acute disseminated encephalomyelitis: updates on an inflammatory CNS syndrome Neurology 2016;87:s38-s45 160 Alper G, Schor NF Toward the definition of acute disseminated encephalitis of childhood Curr Opin Pediatr 2004;16:637-640 161 Leake, JA, Albani S, Kao AS, et al Acute disseminated encephalomyelitis in childhood: epidemiology, clinical, and laboratory features Pediatr Infect Dis J 2004;23:756-764 162 Tenembaum S, Chamoles N, Fejerman N Acute disseminated encephalomyelitis: a long-term follow-up study of 84 pediatric patients Neurology 2002;59:1224-1231 163 Baxter R, Lewis E, Goddard K, et al Acute demyelinating events following vaccines: a case-centered analysis Clin Infect Dis 2016; 63:1456-1462 164 Chen Y, Ma F, Xu Y, et al Vaccines and the risk of acute disseminated encephalomyelitis Vaccines 2018;36:3733-3739 165 Absoud M, Parslow RC, Wassmer E, et al Severe acute disseminated encephalomyelitis: a paediatric intensive care populationbased study Mult Scler 2011;17:1258-1261 166 Alper G, Heyman R, Wang L Multiple sclerosis and acute disseminated encephalomyelitis diagnosed in children after long-term follow-up: comparison of presenting features Dev Med Child Neurol 2009;51:480-486 167 Callen DJ, Shroff MM, Branson HM, et al Role of MRI in the differentiation of ADEM from MS in children Neurology 2009; 72:968-973 168 Tenembaum SN Acute disseminated encephalomyelitis Handb Clin Neurol 2013;112:1253-1262 169 Dale RC, de Sousa C, Chong WK, et al Acute disseminated encephalomyelitis, multiphasic disseminated encephalomyelitis and multiple sclerosis in children Brain 2000;123:2407-2422 170 Khurana DS, Melvin JJ, Kothare SV, et al Acute disseminated encephalomyelitis in children: discordant neurologic and neuroimaging abnormalities and response to plasmapheresis Pediatr 2005;116:431-436 171 Prineas J, McDonald WI, Franklin R Demyelinating diseases In: Graham D, Lantos P, eds Greenfield’s Neuropathology 7th ed London: CRC Press; 2002:471-550 172 Young NP, Weinshenker BG, Parisi JE, et al Perivenous demyelination: association with clinically defined acute disseminated encephalomyelitis and comparison with pathologically confirmed multiple sclerosis Brain 2010;133:333-348 173 Hickey WF Basic principles of immunological surveillance of the normal central nervous system Glia 2001;36:118-124 174 McCoy L, Tsunoda I, Fujinami RS Multiple sclerosis and virus induced immune responses: autoimmunity can be primed by molecular mimicry and augmented by bystander activation Autoimmunity 2006;39:9-19 175 Idrissova ZR, Boldyreva MN, Dekonenko EP, et al Acute disseminated encephalomyelitis in children: clinical features and HLA-DR linkage Eur J Neurol 2003;10:537-546 176 Pohl D, Hennemuth I, von Kries R, et al Paediatric multiple sclerosis and acute disseminated encephalomyelitis in Germany: results of a nationwide survey Eur J Pediatr 2007;166:405-412 e5 177 Callen DJ, Shroff MM, Branson HM, et al Role of MRI in the differentiation of ADEM from MS in children Neurology 2009;72:968-973 178 Tunkel A, Glaser CA, Bloch KC, et al The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America Clin Infect Dis 2008;47:303-327 179 Anlar B, Basaran C, Kose G, et al Acute disseminated encephalomyelitis in children: outcome and prognosis Neuropediatrics 2003; 34:194-199 180 Wingerchuk DM, Banwell B, Bennett JL, et al International consensus diagnostic criteria for neuromyelitis optica spectrum disorders Neurology 2015;85:177-189 181 Hennes EM, Baumann M, Lechner C, et al MOG spectrum disorders and role of MOG-antibodies in clinical practice Neuropediatrics 2018;49:3-11 e6 Abstract: Central nervous system (CNS) infections often require care in the pediatric intensive care unit These can include meningitis, encephalitis, abscesses, and postinfectious inflammatory responses Care of these patients requires a knowledge of epidemiology, classic signs, predisposing factors, appropriate diagnostic tools, and correct treatment strategies Key words: meningitis, encephalitis, acute disseminated encephalomyelitis, brain abscess, subdural empyema 68 Acute Neuromuscular Disease and Disorders MARIA WEIMER, JAMES J REESE JR, AND ANN H TILTON PEARLS • Common causes of acute flaccid paralysis in childhood include Guillain-Barré syndrome (GBS), acute flaccid myelitis, botulism, tick paralysis, periodic paralyses, and organophosphate poisoning • Risk factors for respiratory failure in GBS include elevated cerebrospinal fluid protein during the first week of disease, short time interval between prodrome and onset of GBS symptoms, cranial nerve involvement, myasthenia gravis symptoms, ptosis, diplopia, pupillary sparing, and weakness that waxes and wanes • Asbury criteria for GBS include required criteria, that is, progressive motor weakness of more than one limb and areflexia, and supportive criteria, that is, symmetry of symptoms, mild sensory changes, cranial nerve involvement, and autonomic symptoms Recovery begins to weeks after symptom progression discontinues • Classic botulism symptoms include weak cry, poor suck and swallow, decreased tone, decreased reflexes, weakness in descending pattern, constipation, and autonomic symptoms— especially tachycardia and fluctuating blood pressure, urinary retention, decreased tears and saliva, and flushed skin or pallor Neuromuscular diseases that encompass the entire motor unit may have similar presentations initially and must be deciphered in a methodical manner The motor unit consists of the anterior horn cell, which is located in the spinal cord and terminates in a motor nerve; the myelin associated with the nerve; the neuromuscular junction; and the muscle that the nerve innervates Any disruption of function along this pathway may produce weakness of some variety Neuropathies and myopathies have similar clinical findings, including weakness and decreased or absent reflexes These disease processes may be distinguished, however, by sensory abnormalities and the distribution of the weakness Neuromuscular junction defects may have reflexes present, as in myasthenia gravis, or absent, as seen in tick paralysis The clinician can narrow the etiologic possibilities by considering the clinical presentation, family history, recent illness, travel, inciting factors, and the clinical course This chapter is devoted to acute neuromuscular diseases that present to a pediatric intensive care unit (PICU) Although clinicians may encounter a variety of neuromuscular illnesses, this chapter begins with the most common disorders presenting to the PICU Weakness due to spinal cord or other central nervous system abnormalities are discussed in other chapters differential diagnosis However, this history may be difficult to obtain, particularly if the patient is a small child or infant GBS is the most common cause of acute flaccid paralysis in children, with an incidence estimated to be 0.38 to 1.1 per 100,000 in a population younger than 15 years.1,2 A prodromal respiratory or gastrointestinal illness is commonly reported These illnesses may include Campylobacter jejuni and cytomegalovirus (CMV) In one study, 70% of patients reported an illness before the onset of symptoms, with 26% having documented CMV.3 Alternatively, patients may develop GBS within week after Zika virus infection; most patients in one cohort had a complete recovery.4,5 Neurologic symptoms typically present with progressive paralysis that is relatively symmetric and may evolve to all extremities Other symptoms include varying degrees of hyporeflexia or areflexia, or even respiratory embarrassment Presentations may include acute ataxia, pain, or cranial neuropathies.6,7 Of note, pain is often a major complaint in the young child and makes the examination difficult In one study, risk factors for patients requiring ventilation included cranial nerve involvement, elevated cerebrospinal fluid (CSF) protein during the first week of illness, and a short period between antecedent illness and onset of symptoms.8 Autonomic symptoms may be overlooked Autonomic instability, particularly cardiac arrhythmias, increases morbidity associated with GBS Cardiac monitoring of the R-R interval with reduction of beat-to-beat variability may identify patients at risk for fatal arrhythmia.9 Cardiac arrhythmias induced by tracheal tube manipulation have been reported.10 Additionally, hyponatremia may occur as an occasional complication and is associated Guillain-Barré Syndrome The most common acute neuromuscular disease to present to the PICU is Guillain-Barré syndrome (GBS) When given the history of an ascending paralysis, a clinician can easily place GBS in the 837 ... that the nerve innervates Any disruption of function along this pathway may produce weakness of some variety Neuropathies and myopathies have similar clinical findings, including weakness and... course This chapter is devoted to acute neuromuscular diseases that present to a pediatric intensive care unit (PICU) Although clinicians may encounter a variety of neuromuscular illnesses, this... Centers for Disease Control and Prevention Rabies https://www cdc.gov/rabies/index.html 143 Bonthius DJ Lymphocytic choriomeningitis virus: an underrecognized cause of neurologic disease in the