Page 350 - Abstract Book KONIKA 18

Neurology

P-NEU-027
Case Report: Guillain-Barré Syndrome in 4-year-old Child

Nurichwani Wardianda, Johanus Edwin
Bunda Aliyah Mother and Child Hospital, Jakarta, Indonesia

Abstract
Background Guillain-Barré syndrome or acute idiopathic polyradiculoneuritis is a rare and serious immune-
mediated peripheral neuropathic disorder. It is frequently preceded by an unspecified infection and has a
characteristic symptoms such as areflexia, flaccidity and symmetrical ascending weakness. This syndrome
is much rarer in children and adolescents, with an incidence of 0.62 cases per 100,000 person years in 0-9
year olds. Objective To improve the early recognition and diagnosis of Gullain-Barré Syndrome in children.
Case A 4-year-old male patient was brought to the hospital due to abdominal pain for a week. The patient
also complained of diarrhoea for one day before admission. Other symptoms such as fever, vomiting, cough
were not found. On the fourth day of hospitalisation, the patient felt weakness in both legs and ascended
to arms. The patient began to speak incoherently and choked while drinking. The patient was transferred
to the PICU due to difficulty breathing and was put on a ventilator. On the physical examination, there was
flaccidity, hyporeflexia, and decreased motor strength in the lower extremity that ascended to the upper
extremity. There was no significant abnormality in the laboratory result. The patient was given oxygen
supplementation by a ventilator, IVIG, and crystalloid fluid. After the third day of using IVIG, there was
a slight improvement of motor strength at the right lower extremity and response for communication. The
patient was hospitalized for 7 days and then referred to RSCM. Conclusion Although rare, it’s important to
recognize the variety and severity of the neurological symptoms of GBS in children.
Keywords: Guillain-Barré syndrome; children

P-NEU-028
Improvement of Multiple Bacterial Brain Abscess in Child Following Abscesses
Aspiration and Administration of Antibiotics: A Case Report

Irwan Santoso, Agung Triono
Departement of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/
Dr. Sardjito Hospital, Special District of Yogyakarta, Central Java, Indonesia
Abstract
Background Childhood brain abscess is a rare focal infection of the brain that begins as a localized area of
cerebritis and often involving patients with specific risk factors. Bacteria are responsible for >95% of brain
abscesses through hematogenous dissemination following cyanotic heart disease (26%) and contiguous spread
following otogenic infection (25%). Treatment of brain abscess requires a combination of antimicrobials
and surgical intervention. Objective To demonstrate a long-term outcome of a child with multiple brain
abscesses after antibiotics and surgical intervention. Case An eighteen-month-old male was referred from
a private hospital with cranial nerve palsy and altered consciousness due to meningoencephalitis. Three
weeks prior, the patient had fever, vomiting, and purulent ear discharge. Two days prior he had frequent
vomiting, oculomotor and facial nerve palsy, and altered consciousness. He was then hospitalized in a private
hospital for two days, but no clinical improvement thus referred to our hospital. His initial PCS was 13 and
neurological examination shown cranial nerve palsy and right hemiparesis. Laboratory studies revealed
leucocyte 21.010/ µL with neutrophil 76,8% and contrast head CT revealed multiple hypodense lesions
with rim enhancement and midline shifting. We administered intracranial dose cefotaxime, dexamethasone,
and mannitol. The neurosurgeon performed abscess aspiration three times at two weeks intervals. Abscess
fluid culture revealed chains cocci – Streptococci. The patient became compos mentis and cranial nerve
became normal after the first aspiration. On the 55 day of hospitalization, he was discharged with normal
th
consciousness and cranial nerve but right hemiparesis persisted. One year after the first aspiration, contrast
head CT revealed no brain abscess. Conclusion Altered consciousness, cranial nerve palsy and hemiparesis
can be caused by brain abscess from child with specific risk factors. Combination of neurosurgery and
adequate antibiotic made prognosis better.
Keywords: brain abscess; abscess aspiration; intracranial dose antibiotics

302 KONIKA XVIII Abstract Book