Moyamoya disease and sagittal sinus thrombosis in a child with Down's syndrome

A girl with Down's syndrome, moyamoya disease and sagittal sinus thrombosis is described. She was diagnosed after acute neurological deterioration by MRI and angiography. Recombinant tissue plasminogen activator (r-TPA) was injected locally to recanalise the thrombus. The patient's condition significantly improved and she was discharged. After 2 years of follow-up the child remains asymptomatic. Moyamoya syndrome and cerebral venous thrombosis should not be overlooked as a cause of acute neurological deterioration in a child with Down's syndrome. MRA appears to be a safe and accurate alternative to traditional angiography for the diagnosis of moyamoya disease. Local fibrinolysis with r-TPA is the treatment of choice for cerebral venous thrombosis due to its safety and efficacy.

[Etiology of acute respiratory infections in 87 hospitalized children]

OBJECTIVE

The aim of this study was to assess the effectiveness of two microbiologic methods: viral culture and serology for the etiologic study of acute respiratory infections in children under 14 years of age admitted to our hospital.

PATIENTS

From January 1992 to December 1993, a prospective study was carried out in 87 patients with a mean age of two years with the following diagnosis: upper respiratory tract infections (URTI) 19, laryngitis 3, bronchitis 18, bronchiolitis 18, and pneumonia 29.

METHOD

Nasopharyngeal aspirates were collected for virologic culture on cell monolayers in 87 patients. Serologic studies by complement fixation test were carried out in 42 patients older than six months.

RESULTS

The etiologic agent was detected in 54 (62%) of the 87 patients, being the most frequent the respiratory sincitial virus (VRS) with 18 cases (20%), followed by adenovirus (ADV) in 17 (19%) and Mycoplasma pneumoniae in 9 cases (11%). Viral culture was positive in 32 (37%), being ADV in 14 (41%), and RSV in 9 (26%). Significative serologic studies were obtained in 25 (60%) of the 42 studied patients, with VRS in 9 (32%) and M. pneumoniae in 9 (32%). Concerning clinical diagnosis, the major effectiveness corresponded to serology in pneumonia (76%), and to viral culture in URTI (63%).

CONCLUSION

Viral culture and serology are useful methods for the detection of etiologic agents in acute respiratory infections. The serology effectiveness increases with age (p < 0.01) and the severity of the clinical diagnosis. Both methods have limited usefulness from clinical point of view.