Meningoencephalitis

Varicella
A case report
Background
• Neurological complications of varicella-zoster virus (VZV) infection are
estimated 0.01%-0.03%.
• Central nerve system involvement: cerebellar ataxia (30.9%),
encephalitis (20.2%), isolated seizure (19%), meningitis (11.9%),
stroke (11.9%), GBS (2.3%), ADEM (2.3%), Ramsay Hunt syndrome
(1.2%).
•  Acute complications symptoms occurred approximately 5 days after
rash onset.
• Complete neurologic recovery seen in acute cerebellar ataxia,
isolated seizures and meningitis.
• In contrast, one-third of children with encephalitis or ADEM died or
suffered long-term neurologic sequelae.
 Case illustration
• An 11 years-old boy presented with general tonic-clonic seizure7 days after fever and
itchy vesicular rash all over the body.
• Clinical findings: febrile, hemodinamically stable, drowsy but easily awaken, crusted
rash.
• Neurological finding: neck stiffness and sign of upper motor neuron (UMN) lesion.
• The cerebrospinal fluid (CSF) analysis: 127 cells/uL, 70% mononuclear cells, a protein
level of 0.02 g/dL, and glucose levels 59 mg/dL.
• Head CT Scan: cerebral edema with cerebritis with arachnoid cyst on posterior fossa.
• PCR test did not perform due to limited sources.
• Therapy: acyclovir, manitol, and phenytoin maintenance
• The patient had no more seizure and fully alert 5 days following the treatment.
Summary
• The involvement of central nerve system in VZV infection, manifest as
meningoencephalitis has favorable neurological outcome after
adequate treatment given.
Keywords
• varicella-zoster infection, meningitis varicella, encephalitis varicella,
meningoencephalitis varicella
Hypoplastic Left Heart
Syndrome
A case report
Background
• Hypoplastic left heart syndrome (HLHS) is a constellation of cardiac
malformations, characterized by underdevelopment or absence of
the left ventricle.
• Features of HLHS include varying degrees of hypoplasia of the left
ventricle, mitral valve and aortic valve atresia or stenosis, and
hypoplasia of the ascending aorta.
• The prevalence of HLHS is approximately 2 per 10,000 livebirths.
• It is fatal without surgical intervention, 15%±4% of infants died on the
first day of life, 70%±5% died within the first week of life and 91%±3%
died within 30 days and also responsible for 25% to 40% of all
neonatal cardiac mortality.
Case illustration
• A term newborn baby presented with respiratory distress, cyanosis,
desaturated, but no murmur was noted.
• The chest x-ray showed normal configuration of the heart
• The echocardiography revealed aortic atresia, practically mitral
atresia, hypoplastic of the left ventricle, severe valvular pulmonary
stenosis, large patent ductus arteriosus, and small atrial septal defect.
• The surgical intervention had not performed yet because of limited
resources.
• Unfortunately, the baby passed away after 10 days of hospitalization
with palliative care.
Summary
• Burden in managing newborn with HLHS within this case is closely
related with the limited resources to perform surgical intervention.
The complexity of the defects contributes to the poor outcome.
Keywords
hypoplastic left heart syndrome, left ventricle hypoplasia, aortic valve
atresia, cyanotic cardiac malformation.