Page 70 - Proceeding of Plenary Abstract of Parallel Symposim

NEUROLOGI

How to Differentiate CNS Infection and Autoimmune Encephalitis in Children

Johannes H. Saing
Departement of Child Health, Faculty of Medicine Universitas Sumatera Utara/Haji Adam Malik General Hospital, Medan, North Sumatera, Indonesia
Abstract
Background Infectious encephalitis (IE) and autoimmune encephalitis (AE) are symptomatically similar in
clinic, however essentially different in pathogenesis. They are difficult to distinguish, thus bringing ambiguities
in the treatments and managements. Objective To review the typical clinical and radiological features of
infectious and autoimmune encephalitis. Discussion Encephalitis is a severe form of a neurological disease
caused by an inflammation of the brain parenchyma associated with evidence of neurologic disfunction. The
frequency of this condition is higher in children, presenting in this age group a great potential of severity,
and higher risks of morbidity and mortality. There are more than 100 different etiologies that can lead to
encephalitis in children; however, most researchers have found that the majority (50%–70%) of patients lack
an identified etiology. Pediatric encephalitides can be categorized as infectious or autoimmune. Infectious
encephalitis (IE) and autoimmune encephalitis (AE) are symptomatically similar in clinic, however essentially
different in pathogenesis. They are difficult to distinguish, thus bringing ambiguities in the treatments and
managements. Autoimmune and viral encephalitides can resemble one another and sometimes autoimmune
encephalitis may have parainfectious association. Early diagnosis and treatment was the key to management
of both causes, which emphasizes the importance of clinical diagnosis. Conclusion The combination of
symptomatic differences was potentially useful for preliminary distinguishing of AE and IE in clinic.
Involuntary movement and memory deficits were more specifically present in AE patients. CSF, blood routine
test and hippocampus lesions detections were potential markers for distinguishing AE and IE.
Keywords: infectious; autoimmune; encephalitis

Pearls and Pitfalls in Diagnose and Early Detection of Cerebral Palsy

Nurcahaya Sinaga
Departement of Child Health, Faculty of Medicine Universitas Muhammadiyah Sumatera Utara/Haji Medan Hospital, Medan, North Sumatera, Indonesia

Abstract
Background Cerebral Palsy (CP) is a disorder of movement and posture that appears during infancy or
early childhood. CP is a wide variety of static neuromotor impairment syndromes that occurred secondary
by a lesion in the developing brain. This lesion is permanent and cannot be cured but the consequences can
be minimized. Objective How to diagnose and detection early of cerebral palsy. Discussion Progressive
musculoskeletal pathology occurs in most affected children. The lesion in the brain may occur during
the prenatal, perinatal, or postnatal periods. There are three types of motor problems. Children showed
neuromotor developmental delay in infancy. Primitive reflexes persist and advanced postural reactions do
not appear in the child with CP. Clinical signs and symptoms of cerebral palsy emerged and evolved before
age 2 years; therefore, an examination and clinical history should be used to predicted risk of CP. Before age
12 to 24 months was regarded as the latent period where cerebral palsy could not be identified accurately.
The experts now consider the latent period was outdated because CP or “high risk of CP” can be accurately
predicted before 6 months corrected age. Early signs of CP in infant are abnormal behavior, oromotor and
mobility problems. Before 5 and after 5 months corrected age, predictived examination for detecting risk were
magnetic resonance imaging, the Hammersmith Infant Neurological Examination, and the Developmental
Assessment of Young Children. One needs to distinguish CP from progressive disorders of childhood. It
may not be always necessary to find the exact cause because this does not change the management for most
children. Neuromuscular disorder, global developmental delayed, mental retardation syndromes, attention
deficit disorder, autisme and non-motor handicaps such as blindness and emotional disorders also cause motor
delay.

Kongres Nasional Ilmu Kesehatan Anak XVIII 55