1
|
Held M, Sestan M, Kifer N, Jelusic M. Cerebrovascular involvement in systemic childhood vasculitides. Clin Rheumatol 2023; 42:2733-2746. [PMID: 36884156 DOI: 10.1007/s10067-023-06552-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/02/2023] [Accepted: 02/15/2023] [Indexed: 03/09/2023]
Abstract
Pediatric vasculitides sometimes involve central nervous system (CNS). The manifestations are diverse, ranging from headache, seizures, vertigo, ataxia, behavioral changes, neuropsychiatric symptoms, consciousness disorders, and even cerebrovascular (CV) accidents that may lead to irreversible impairment and even death. Stroke, on the other hand despite the great progress in prevention and treatment, is still one of the leading causes of morbidity and mortality in the general population. The aim of this article was to summarize CNS manifestations and CV issues observed in primary pediatric vasculitides and the current knowledge of etiology and CV risk factors, preventive strategies, and therapeutic options in this target patient population. Pathophysiological links reveal similar immunological mechanisms involved in both pediatric vasculitides and CV events with endothelial injury and damage being the central point. From the clinical point of view, CV events in pediatric vasculitides were associated with increased morbidity and poor prognosis. If damage has already occurred, the therapeutic approach consists of good management of the vasculitis itself, antiplatelet and anticoagulation therapy, and early rehabilitation. Risk factors for acquiring cerebrovascular disease (CVD) and stroke, particularly hypertension and early atherosclerotic changes, already begin in childhood, with vessel wall inflammation contributing itself, once more emphasizing that appropriate preventive measures are certainly necessary in pediatric vasculitis population to improve their long-term outcome.
Collapse
Affiliation(s)
- Martina Held
- Department of Pediatrics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mario Sestan
- Department of Pediatrics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Nastasia Kifer
- Department of Pediatrics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marija Jelusic
- Department of Pediatrics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.
- Division of Clinical Immunology, Rheumatology and Allergology, Centre of Reference for Paediatric and Adolescent Rheumatology of Ministry of Health of the Republic Croatia, University Hospital Centre Zagreb, Kispaticeva 12, 10 000, Zagreb, Croatia.
| |
Collapse
|
2
|
Laukka D, Parkkola R, Hirvonen J, Ylikotila P, Vahlberg T, Salo E, Kivelev J, Rinne J, Rahi M. Brain white matter hyperintensities in Kawasaki disease: A case–control study. Front Neurosci 2022; 16:995480. [PMID: 36330348 PMCID: PMC9623056 DOI: 10.3389/fnins.2022.995480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background Cerebrovascular involvement of Kawasaki disease (KD) is poorly studied. White matter hyperintensities (WMH) indicate cerebral small vessel disease and increase the risk for stroke. Purpose To investigate whether childhood KD is associated with WMHs and other cerebrovascular findings later in adulthood. Materials and methods In this case-control study, patients diagnosed with KD (cases) at our tertiary hospital between 1978 and 1995 were invited to brain magnetic resonance (MRI) between 2016 and 2017. Migraine patients (controls) with available brain MRI were matched with cases (ratio 4:1) by age (±2 years) and sex. Two blinded neuroradiologists evaluated independently cerebrovascular findings from the brain MRI scans. Modified Scheltens' visual rating scale was used to evaluate WMH burden and the total WMH volume was measured using manual segmentation. Results Mean age [years, (SD)] at the time of brain MRI was 33.3 (3.8) and 32.8 (4.0) for cases (n = 40) and controls (n = 160), respectively (P = 0.53). Mean follow-up time for cases was 29.5 years (4.3). Total volume of WMHs (median) was 0.26 cm3 (IQR 0.34) for cases and 0.065 cm3 (IQR 0.075) for controls, P = 0.039. Cases had higher total WMH burden (P = 0.003), deep WMH burden (P = 0.003), and more periventricular WMHs (prevalence 7.5 vs. 0%, P = 0.008) than controls. Cases had greater risk of having total Scheltens' score ≥2 vs. < 2 (odds ratio, 6.88; 95% CI: 1.84–25.72, P = 0.0041) and ≥3 vs. < 3 (odds ratio, 22.71; 95% CI: 2.57–200.53, P = 0.0049). Diabetes type 1/type 2, hypertension, smoking status or hypercholesterolemia were not risk factors for WMH burden, p > 0.1. Myocarditis at the acute phase of KD increased the risk for periventricular WMHs (P < 0.05). Three cases (7.5%) and three controls (1.9%) had lacune of presumed vascular origin (P = 0.0096). Conclusion History of KD could be associated with an increased WMH burden. More studies are needed to confirm our results.
Collapse
Affiliation(s)
- Dan Laukka
- Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
- *Correspondence: Dan Laukka
| | - Riitta Parkkola
- Department of Radiology, Turku University Hospital, University of Turku, Turku, Finland
| | - Jussi Hirvonen
- Department of Radiology, Turku University Hospital, University of Turku, Turku, Finland
| | - Pauli Ylikotila
- Clinical Neurosciences, University of Turku, Turku, Finland
- Neurocenter, Turku University Hospital, Turku, Finland
| | - Tero Vahlberg
- Department of Clinical Medicine, Biostatistics, University of Turku, Turku, Finland
| | - Eeva Salo
- Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Juri Kivelev
- Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
| | - Jaakko Rinne
- Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
| | - Melissa Rahi
- Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
| |
Collapse
|
3
|
Lin CH, Lai JN, Lee IC, Chou IC, Lin WD, Lin MC, Hong SY. Kawasaki Disease May Increase the Risk of Subsequent Cerebrovascular Disease. Stroke 2021; 53:1256-1262. [PMID: 34844424 DOI: 10.1161/strokeaha.120.032953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Previous epidemiological investigations examining the association between Kawasaki disease (KD) and cerebrovascular disease have had conflicting results. We analyzed the association between KD and cerebrovascular disease by conducting a population-based retrospective cohort study designed to investigate the hypothesis that KD could be a risk factor for subsequent cerebrovascular disease. METHODS From the National Health Insurance Research Database of Taiwan, the data of children (aged 0-18 years old) with KD (n=8467) were collected. Starting with the first year of study observation (referred to as the baseline year), data was collected for each child with KD, and 4 non-KD patients matched for sex, urbanization level of residence, and parental occupation were randomly selected to form the non-KD cohort (n=33 868) for our analysis. For the period from January 1, 2000, to December 31, 2012, we calculated the follow-up person-years for each patient, which is the time from the index date to the diagnosis of cerebrovascular disease, death, or the end of 2012. Furthermore, we compared the incidence, the incidence rate ratio, and the 95% CI of cerebrovascular disease between the KD and non-KD cohorts. RESULTS The overall cerebrovascular disease incidence rate was found to be 3.19-fold higher, which is significantly higher, in the KD cohort than in the non-KD cohort (14.73 versus 4.62 per 100 000 person-years), and the overall risk of cerebrovascular disease remained higher in the KD cohort (adjusted hazard ratio, 3.16 [95% CI, 1.46-6.85]). Furthermore, children aged <5 years showed a significantly higher risk of subsequent cerebrovascular disease in the KD cohort (adjusted hazard ratio, 3.14 [95% CI, 1.43-6.92]). CONCLUSIONS This nationwide retrospective cohort study shows that KD may increase the risk of subsequent cerebrovascular disease, especially in those with KD aged <5 years old.
Collapse
Affiliation(s)
- Chien-Heng Lin
- Division of Pediatric Pulmonology, China Medical University Children's Hospital, Taichung, Taiwan. (C.-H.L.).,Department of Biomedical Imaging and Radiological Science, College of Medicine, China Medical University, Taichung, Taiwan. (C.-H.L.)
| | - Jung-Nien Lai
- Department of Chinese Medicine, China Medical University Hospital, Taiwan. (J.-N.L.)
| | - Inn-Chi Lee
- Department of Pediatrics, Chung Shan Medical University Hospital and Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan (I.-C.L.)
| | - I-Ching Chou
- Division of Pediatric Neurology, China Medical University Children's Hospital, Taichung, Taiwan. (I.-C.C., S.-Y.H.).,Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan. (I.-C.C.)
| | - Wei-De Lin
- Department of Medical Research, China Medical University Hospital, Taiwan. (W.-D.L.)
| | - Mei-Chen Lin
- College of Medicine, China Medical University, Taichung, Taiwan. (M.-C.L.).,Management Office for Health Data, China Medical University Hospital, Taiwan. (M.-C.L.)
| | - Syuan-Yu Hong
- Division of Pediatric Neurology, China Medical University Children's Hospital, Taichung, Taiwan. (I.-C.C., S.-Y.H.).,Institute of Biomedicine, School of Medicine, China Medical University, Taichung, Taiwan. (S.-Y.H.).,Department of Medicine, School of Medicine, China Medical University, Taichung, Taiwan. (S.-Y.H.)
| |
Collapse
|
4
|
Wang L, Duan H, Zhou K, Hua Y, Liu X, Wang C. Kawasaki Disease Complicated by Late-Onset Fatal Cerebral Infarction: A Case Report and Literature Review. Front Pediatr 2021; 9:598867. [PMID: 34095019 PMCID: PMC8170391 DOI: 10.3389/fped.2021.598867] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 03/29/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Cerebral infarction is a rare neurological complication of Kawasaki disease (KD) and occurs in the acute or subacute stage. There have been no reported cases of late-onset fatal cerebral infarction presenting over 1 year after the onset of KD. Case Presentation: A 5-month-old male patient with KD received timely intravenous immunoglobulin therapy; however, extensive coronary artery aneurysms (CAA) and coronary artery thrombosis (CAT) developed 1 month later. Anticoagulation and thrombolytic agents were suggested, but the child's parents refused. Fifteen months after KD onset, an attack of syncope left him with left hemiplegia; brain computerized tomography (CT) scans revealed cerebral infarction of the right basal ganglion without hemorrhage. Magnetic resonance angiography (MRA) revealed severe stenosis of the right middle cerebral artery, and a series of tests were performed to exclude other causes of cerebral infarction. Considering the cerebral infarction and CAT, combination therapy with urokinase and low-molecular-weight heparin (LMWH) was initiated within 24 h of syncope onset, together with oral aspirin and clopidogrel. Five days later, his clinical symptoms partially regressed and he was discharged. Unfortunately, 5 days after discharge, his clinical condition suddenly deteriorated. Repeat brain CT showed hemorrhagic stroke involving the entire left cerebral area, in addition to the previous cerebral infarction in the right basal ganglion, with obvious secondary cerebral swelling and edema, which might have been caused by previous thrombolysis. Severe cerebral hernias developed quickly. Regrettably, the patient's parents abandoned treatment because of economic factors and unfavorable prognosis, and he died soon after. Conclusions: Cerebral infarction and cerebral artery stenosis can develop late, even 1 year after the onset of KD. Pediatricians should be aware of the possibility of cerebrovascular involvement in addition to cardiac complications during long-term follow-up of KD patients. Prompt anticoagulation therapy and regular neuroimaging evaluation are essential for the management of patients with KD with giant CAA and/or CAT.
Collapse
Affiliation(s)
- Lin Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education Chengdu, Sichuan University, Chengdu, China
| | - Hongyu Duan
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education Chengdu, Sichuan University, Chengdu, China
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, China
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Kaiyu Zhou
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education Chengdu, Sichuan University, Chengdu, China
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, China
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yimin Hua
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education Chengdu, Sichuan University, Chengdu, China
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, China
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiaoliang Liu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education Chengdu, Sichuan University, Chengdu, China
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Chuan Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education Chengdu, Sichuan University, Chengdu, China
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, China
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
5
|
Masiello E, Buonsenso D, Lazzareschi I, Gatto A, Piastra M, Chiaretti A, Valentini P. Case Report: Kawasaki Shock Syndrome With Polycyclic Eruption: A Peculiar Brain Imaging. Front Pediatr 2021; 9:651457. [PMID: 34722412 PMCID: PMC8555708 DOI: 10.3389/fped.2021.651457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 09/06/2021] [Indexed: 11/26/2022] Open
Abstract
Kawasaki disease (KD) is a childhood vasculitis of unknown etiology. The present study describes a case of KD shock syndrome that occurred in an infant (age, 16 months) following 7 days of high fever and persistent rash characterized by target-like and purpuric skin lesions. The child developed neurological manifestations such as altered consciousness and irritability. Consequently, brain magnetic resonance imaging (MRI) was performed, revealing an inflammatory involvement of the anterior perforated substance and the hypothalamus. Cerebral involvement on brain MRI is rarely described in KD but when reported is characterized mostly by cerebral vasculitis. We illustrate for the first time in KD an inflammation in the brain not related to vasculitis, reporting peculiar neuroradiological findings. This last aspect has fascinated us in light of recent evidence about the immunological spectrum of Multisystem Inflammatory Syndrome in Children (MIS-C) and Kawasaki-like syndrome in the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) outbreak.
Collapse
Affiliation(s)
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ilaria Lazzareschi
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Gatto
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Piastra
- Department of Pediatric ICU, Intensive Care and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Chiaretti
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| |
Collapse
|
6
|
Infliximab Therapy and the Central Nervous Demyelination in Patients with Kawasaki Disease. Pediatr Infect Dis J 2019; 38:e185-e187. [PMID: 31107420 DOI: 10.1097/inf.0000000000002296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We performed brain magnetic resonance imaging in 14 patients with Kawasaki disease who were treated with infliximab (IFX) at 56 months of age (32-62 months of age) and 23 months (5-35 months) after IFX therapy. Magnetic resonance imaging showed no finding of the central nervous demyelination. IFX therapy is not related to central nervous demyelination in patients with Kawasaki disease.
Collapse
|
7
|
Yeom JS, Cho JY, Woo HO. Understanding the importance of cerebrovascular involvement in Kawasaki disease. KOREAN JOURNAL OF PEDIATRICS 2019; 62:334-339. [PMID: 31096739 PMCID: PMC6753317 DOI: 10.3345/kjp.2019.00143] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/15/2019] [Indexed: 12/19/2022]
Abstract
Kawasaki disease (KD) is a systemic vasculitis in infants and young children. However, its natural history has not been fully elucidated because the first case was reported in the late 1960s and patients who have recovered are just now entering middle age. Nevertheless, much evidence has raised concerns regarding the subclinical vascular changes that occur in post-KD patients. KD research has focused on coronary artery aneurysms because they are directly associated with fatality. However, aneurysms have been reported in other extracardiac muscular arteries and their fate seems to resemble that of coronary artery aneurysms. Arterial strokes in KD cases are rarely reported. Asymptomatic ischemic lesions were observed in a prospective study of brain vascular lesions in KD patients with coronary artery aneurysms. The findings of a study of single-photon emission computed tomography suggested that asymptomatic cerebral vasculitis is more common than we believed. Some authors assumed that the need to consider the possibility of brain vascular lesions in severe cases of KD regardless of presence or absence of neurological symptoms. These findings suggest that KD is related with cerebrovascular lesions in children and young adults. Considering the fatal consequences of cerebral vascular involvement in KD patients, increased attention is required. Here we review our understanding of brain vascular involvement in KD.
Collapse
Affiliation(s)
- Jung Sook Yeom
- Department of Pediatrics, Gyeongsang National University Hospital, Gyeongsang Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jae Young Cho
- Department of Pediatrics, Gyeongsang National University Hospital, Gyeongsang Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Hyang-Ok Woo
- Department of Pediatrics, Gyeongsang National University Hospital, Gyeongsang Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea
| |
Collapse
|
8
|
Abstract
The vasculitides are diseases characterized by inflammation of blood vessels and inflammatory leukocytes in vessel walls. There is an increased propensity for ischemic stroke, resulting from compromise of vessel lumina with distal tissue ischemia; and hemorrhagic or nonhemorrhagic stroke, and aneurysmal formation and bleeding, due to loss of vessel integrity.
Collapse
Affiliation(s)
- David S Younger
- Department of Neurology, Division of Neuro-Epidemiology, New York University School of Medicine, New York, NY, USA; School of Public Health, City University of New York, New York, NY, USA.
| |
Collapse
|
9
|
Laukka D, Rahi M, Parkkola R, Vahlberg T, Rintala A, Salo E, Rinne J. Unlikely association between Kawasaki disease and intracranial aneurysms: a prospective cohort study. J Neurosurg Pediatr 2019; 23:593-596. [PMID: 30771761 DOI: 10.3171/2018.11.peds18575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/28/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Kawasaki disease (KD) is a vasculitis that can cause aneurysm formation in coronary arteries and, more rarely, in peripheral arteries. A possible connection between KD and intracranial aneurysms is unclear. The purpose of this study was to determine if KD is associated with intracranial aneurysms. METHODS In this prospective cohort study, all patients hospitalized and diagnosed with KD in the authors' hospital district area in the period from 1978 to 1995 were identified. Patients with a current age ≥ 25 years and a history of KD in childhood were included in the study, which was conducted between 2016 and 2017. Magnetic resonance angiography (MRA) of the brain was performed in all patients. RESULTS Forty patients (25 males), whose mean age was 33.5 ± 3.9 years (mean ± standard deviation), were eligible for study inclusion. The mean age at KD diagnosis was 3.9 ± 3.1 years, and the mean follow-up was 29.5 ± 4.3 years. Six patients (15%) had coronary arterial lesions during the acute illness of KD. None of the patients (0%) had intracranial aneurysms on brain MRA, which is significantly under the prevalence of 10% (95% CI 0%-8.8%, p = 0.03) that is the recommended limit for intracranial aneurysm screening. CONCLUSIONS The study results suggest that KD is not associated with an increased prevalence of intracranial aneurysms and that screening for intracranial aneurysms is not warranted in patients with a history of KD.
Collapse
Affiliation(s)
- Dan Laukka
- 1Department of Neurosurgery, Division of Clinical Neurosciences
| | - Melissa Rahi
- 1Department of Neurosurgery, Division of Clinical Neurosciences
| | | | - Tero Vahlberg
- 3Department of Clinical Medicine, Biostatistics, University of Turku, Turku; and
| | - Arttu Rintala
- 1Department of Neurosurgery, Division of Clinical Neurosciences
| | - Eeva Salo
- 4Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Jaakko Rinne
- 1Department of Neurosurgery, Division of Clinical Neurosciences
| |
Collapse
|
10
|
Rossi M, Siani P, Grossi A, Carannante N, Di Caprio G, Borrelli B, Sbrana F, Di Martino F, Sarno M, Tascini C. Aseptic meningitis as onset of Kawasaki disease. Minerva Pediatr 2019; 72:135-137. [PMID: 30654606 DOI: 10.23736/s0026-4946.19.05384-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Marco Rossi
- First Division of Infectious Disease, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy -
| | - Paolo Siani
- Department of Pediatrics, Santobono-Pausillipon Hospital, Naples, Italy
| | - Adriano Grossi
- First Division of Infectious Disease, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Novella Carannante
- First Division of Infectious Disease, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Giovanni Di Caprio
- First Division of Infectious Disease, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Barbara Borrelli
- Unit of Pediatric Pneumology and UTSIR, Santobono-Pausillipon Hospital, Naples, Italy
| | | | - Filomena Di Martino
- First Division of Infectious Disease, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Marco Sarno
- Department of Pediatrics, Santobono-Pausillipon Hospital, Naples, Italy
| | - Carlo Tascini
- First Division of Infectious Disease, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| |
Collapse
|
11
|
Prangwatanagul W, Limsuwan A. Ischemic stroke in Kawasaki disease. Pediatr Int 2017; 59:92-96. [PMID: 28102623 DOI: 10.1111/ped.13170] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 07/07/2016] [Accepted: 09/01/2016] [Indexed: 11/28/2022]
Abstract
Pediatric stroke is considered to be rare. Stroke resulting from cerebral vasculitis is also uncommon in young children. With the increasing prevalence of Kawasaki disease (KD) diagnosis, this acquired vasculitis has been reported with various clinical presentations including neurological symptoms. Herein we describe the case of a KD patient presenting with stroke. A 15-month-old boy was referred due to stroke that occurred on the fifth day of febrile illness. He was initially admitted to another hospital due to fever and diarrhea. He was discharged and re-admitted 2 days afterward due to left hemiplegia. During the 10 days of the second hospitalization, he had a presumptive diagnosis of encephalomeningitis. Upon referral to the present hospital, he was found to have right middle cerebral artery branch stenosis and fusiform aneurysms of the coronary arteries. Retrospectively, the patient had the full clinical criteria for KD diagnosis. Therefore, stroke could be considered as one of the uncommon clinical manifestations of KD.
Collapse
Affiliation(s)
- Wasana Prangwatanagul
- Division of Pediatric Cardiology, Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Alisa Limsuwan
- Division of Pediatric Cardiology, Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
12
|
Okada S, Hasegawa S, Suzuki Y, Matsubara T, Shimomura M, Okuda M, Ichiyama T, Ohga S. Acute pericardial effusion representing the TNF-α-mediated severe inflammation but not the coronary artery outcome of Kawasaki disease. Scand J Rheumatol 2014; 44:247-52. [DOI: 10.3109/03009742.2014.956140] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
13
|
Sabatier I, Chabrier S, Brun A, Hees L, Cheylus A, Gollub R, Hadjikhani N, Kong J, des Portes V, Floret D, Curie A. Stroke by carotid artery complete occlusion in Kawasaki disease: case report and review of literature. Pediatr Neurol 2013; 49:469-73. [PMID: 24095647 DOI: 10.1016/j.pediatrneurol.2013.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 07/25/2013] [Accepted: 08/11/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Kawasaki disease is an acute and time-limited systemic vasculitis primarily affecting young children. PATIENT We describe an 18-month-old girl with Kawasaki disease who developed cerebral infarction following complete occlusion of her right internal carotid artery. RESULTS The occlusion occurred 10 days after the onset of fever, while she was on high-dose aspirin, and the day after she received intravenous immunoglobulin treatment. We present the first literature review on this very rare complication. CONCLUSION Stroke is a rare neurological complication in Kawasaki disease. Optimal treatment should be begun as soon as possible after diagnosis. Intravenous immunoglobulins seem to reduce the cerebrovascular complications, but evaluation of hydration status is strongly recommended before performing such treatment.
Collapse
Affiliation(s)
- Isabelle Sabatier
- Hospices Civils de Lyon, HFME, Service de Neuropédiatrie, Bron, France; Université Claude Bernard Lyon 1, Lyon, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Gitiaux C, Kossorotoff M, Bergounioux J, Adjadj E, Lesage F, Boddaert N, Hully M, Brugel D, Desguerre I, Bader-Meunier B. Cerebral vasculitis in severe Kawasaki disease: early detection by magnetic resonance imaging and good outcome after intensive treatment. Dev Med Child Neurol 2012; 54:1160-3. [PMID: 23163818 DOI: 10.1111/dmcn.12002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Kawasaki disease is an acute vasculitis, that has a classic complication of acquired coronary artery aneurysm. Severe forms with multi-organ involvement or neurological dysfunction are rare. Cerebral vascular involvement has been related to large-vessel injury or cardioembolism, leading to focal brain infarction. A 4-year-old female presented with unusual, rapidly catastrophic Kawasaki disease with refractory shock, acute renal failure, and coma, requiring intensive haemodynamic management. The observation of diffuse micro-haemorrhages (T2*-weighted sequence) associated with white matter injury on brain magnetic resonance imaging (MRI) pointed towards lesions of the medium/small blood vessels. Cerebral vasculitis was suspected and the immunosuppressive treatment was increased Subsequently, the patient's recovery was rapid. On follow-up severe, bilateral vitritis was evident and surgery improved visual outcome. Early recognition of severe or unusual forms of Kawasaki disease could lead to more favourable outcome using appropriate treatment strategies. Diffuse cerebral micro-haemorrhages on T2* brain MRI sequences might be a key sign for the diagnosis of medium or small cerebral vessel involvement.
Collapse
Affiliation(s)
- Cyril Gitiaux
- Paediatric Neurology Department, Necker-Enfants Malades Hospital, Paris, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Tacke CE, Haverman L, Berk BM, van Rossum MA, Kuipers IM, Grootenhuis MA, Kuijpers TW. Quality of life and behavioral functioning in Dutch children with a history of Kawasaki disease. J Pediatr 2012; 161:314-9.e1. [PMID: 22421262 DOI: 10.1016/j.jpeds.2012.01.071] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 01/17/2012] [Accepted: 01/31/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The authors evaluated health-related quality of life (HRQOL) and behavioral functioning in patients with a history of Kawasaki disease (KD). STUDY DESIGN A cross-sectional study was conducted at a tertiary referral center for KD follow-up in 280 patients (mean age 8.6 years, 60.0% male). Patients were eligible when they were aged 0-18 years and had a history of KD. HRQOL was assessed using the TNO-AZL Preschool Children Quality of Life questionnaire for children 0-5 years old and the Pediatric Inventory of Quality of Life Core Scales 4.0 for those 6-18 years old. Behavioral functioning was evaluated using the Strength and Difficulties Questionnaire (8-16 years proxy report and 11-16 years self-report). KD results were compared with Dutch norm data, and patients with and without coronary artery aneurysms were compared. RESULTS HRQOL was significantly worse for male patients aged 0-5 years on 4 of the 12 TNO-AZL Preschool Children Quality of Life questionnaire scales and for female patients on the motor functioning scale. At an older age, the HRQOL of patients was comparable with the norm population. Coronary artery status did not influence HRQOL. Parents reported more behavioral problems on the hyperactivity and emotional subscale in patients compared with the norm population. CONCLUSIONS Although at an older age the HRQOL of patients with KD is comparable with the Dutch norm, HRQOL seems to be particularly impaired at younger age. Parents reported more hyperactivity and emotional problems in patients with KD.
Collapse
Affiliation(s)
- Carline E Tacke
- Pediatric Hematology, Immunology and Infectious Diseases Department, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
16
|
Hikita T, Kaminaga T, Wakita S, Ogita K, Ikemoto H, Fujii Y, Oba H, Yanagawa Y. Regional cerebral blood flow abnormalities in patients with kawasaki disease. Clin Nucl Med 2011; 36:643-9. [PMID: 21716013 DOI: 10.1097/rlu.0b013e318217adfc] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Kawasaki disease (KD) is an acute febrile disorder of unknown etiology. Brain single-photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI) help in detecting regional cerebral blood flow abnormalities and brain damage. The usefulness of SPECT and MRI in patients with KD was evaluated. MATERIALS AND METHODS All 22 patients with KD underwent brain SPECT using Tc-99m-hexamethyl propylene amine oxime from 6 days to 3 years after onset, and 8 patients underwent brain MRI. Of the 22 patients, 4 had neurologic symptoms. Case 1 showed prolonged apnea; case 2, prolonged disturbance of consciousness; and cases 3 and 4 generalized tonic-clonic seizures. Initial brain SPECT showed localized hypoperfusion in 4 and 13 patients with and without neurologic symptoms, respectively. RESULTS All patients with neurologic symptoms underwent follow-up SPECT; localized hypoperfusion was detected between 1- and 6-month follow-up in 3 of these patients. Six patients without neurologic symptoms underwent follow-up SPECT. Localized hypoperfusion was detected at approximately 1- to 11-month follow-up in 4 of these patients. Diffusion-weighted imaging revealed abnormal high-intensity areas in the corpus callosum in case 1. Case 2 showed a bilateral chronic subdural hematoma with decreased size and ischemic changes, and case 3 showed bilateral hippocampal atrophy and left hippocampal sclerosis. CONCLUSIONS Because the occurrence of localized hypoperfusion is possibly not restricted to only the acute phase in KD, brain SPECT and MRI should also be performed in KD patients with neurologic symptoms.
Collapse
Affiliation(s)
- Toshiyuki Hikita
- Department of Pediatrics, Teikyo University School of Medicine, Itabashi-Ku, Tokyo, Japan
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Alves NRDM, de Magalhães CMR, Almeida RDFR, dos Santos RCR, Gandolfi L, Pratesi R. Prospective study of Kawasaki disease complications: review of 115 cases. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1016/s0104-4230(11)70062-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
18
|
Alves NRDM, de Magalhães CMR, Almeida RDFR, dos Santos RCR, Gandolfi L, Pratesi R. Estudo prospectivo das complicações da Doença de Kawasaki: análise de 115 casos. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1590/s0104-42302011000300012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
|