Purpose: Brain magnetic resonance imaging (MRI) is commonly performed to exclude secondary causes of pediatric headache. Incidental findings are detected in approximately one-fifth of scans, and nonspecific white matter lesions (WMLs) have been reported in 0.7% to 47% of pediatric patients with headache. However, the natural history of these lesions remains unclear. This study aimed to determine the prevalence and radiologic course of WMLs in pediatric patients with headache. Methods: We retrospectively reviewed the clinical and MRI data of pediatric patients who underwent brain MRI for headache at a single tertiary-care center between September 2006 and July 2023. Patients with neurological or systemic conditions known to cause WMLs were excluded. MRI findings and clinical characteristics were analyzed descriptively. Results: Among the 515 enrolled patients (mean age, 10.7 years), abnormal MRI findings were observed in 126 (24.5%), including nonspecific WMLs in eight (1.6%). Most lesions were supratentorial (seven of eight), with a mean maximum diameter of 10.0 mm (range, 4.3 to 24.9). Follow-up MRI was available for three patients; two demonstrated interval increases in lesion extent on repeat imaging. During the same period, headache frequency or severity also increased, but no new neurological deficits were documented. Conclusion Nonspecific WMLs were rare in pediatric patients with headache. In a small subset with limited follow-up, interval radiologic changes were observed without neurological deterioration. Larger prospective studies are needed to clarify the natural history and clinical significance of WMLs in pediatric headache.

Purpose: Exanthem subitum (ES), most commonly caused by human herpesvirus 6B (HHV-6B), is a prevalent febrile illness in infants and toddlers. Previous studies have suggested a possible association between HHV-6B infection and an increased risk of complex febrile seizures (CFS). Given that CFS may prompt additional diagnostic procedures to rule out serious neurological disorders, we compared the clinical characteristics and management of patients with and without ES. Methods: We retrospectively reviewed the medical records of 141 children younger than two years of age who experienced their first febrile seizure between March 2013 and August 2024 at a tertiary medical center. We collected demographic, clinical, and laboratory data and compared clinical profiles between children diagnosed with ES and those without ES. Results: Twenty-eight children (19.9%) were clinically diagnosed with ES. Although the frequency of CFS did not significantly differ between the ES and non-ES groups (42.9% vs. 28.3%, P=0.172), children with ES were more likely to undergo lumbar puncture (42.9% vs. 11.5%, P<0.001) and receive empiric intravenous antibiotics for suspected central nervous system infection (39.3% vs. 10.6%, P<0.001). Conclusion Despite the typically benign and self-limiting nature of ES, febrile seizures occurring in the context of ES appear to be associated with more aggressive diagnostic and therapeutic interventions. The development of rapid, noninvasive diagnostic assays for HHV-6B may help reduce unnecessary procedures and promote more judicious management.

Evaluating cell metabolism is crucial during pluripotent stem cell (PSC) differentiation and somatic cell reprogramming as it affects cell fate. As cultured stem cells are heterogeneous, a comparative analysis of relative metabolism using existing metabolic analysis methods is difficult, resulting in inaccuracies. In this study, we measured human PSC basal metabolic levels using a Seahorse analyzer. We used fibroblasts, human induced PSCs, and human embryonic stem cells to monitor changes in basal metabolic levels according to cell number and determine the number of cells suitable for analysis. We evaluated normalization methods using glucose and selected the most suitable for the metabolic analysis of heterogeneous PSCs during the reprogramming stage. The response of fibroblasts to glucose increased with starvation time, with oxygen consumption rate and extracellular acidification rate responding most effectively to glucose 4 hours after starvation and declining after 5 hours of starvation. Fibroblasts and PSCs achieved appropriate responses to glucose without damaging their metabolism 2∼4 and 2∼3 hours after starvation, respectively. We developed a novel method for comparing basal metabolic rates of fibroblasts and PSCs, focusing on quantitative analysis of glycolysis and oxidative phosphorylation using glucose without enzyme inhibitors. This protocol enables efficient comparison of energy metabolism among cell types, including undifferentiated PSCs, differentiated cells, and cells undergoing cellular reprogramming, and addresses critical issues, such as differences in basal metabolic levels and sensitivity to normalization, providing valuable insights into cellular energetics.

PURPOSE: Bell palsy is an idiopathic peripheral facial nerve paralysis of sudden onset. Though the incidence in children is relatively lower than adult population, it is not uncommon. Because of its' relative rarity and good prognosis, there have been few studies about clinical features and courses of Bell palsy in pediatric population. The aim of our study was to report the clinical characteristics and practices of Bell palsy in children and adolescent in a single center. METHODS: We reviewed medical records of 70 patients diagnosed as Bell palsy in Daegu Catholic University Medical Center from September 2006 to June 2017 retrospectively. We included only first episode. RESULTS: Of the 70 patients, 35 was male, 35 was females. Median age was 102 months. There was no seasonal difference. Median duration of palsy was 3 days. The first symptoms were auricular pain (14%), facial palsy (83%), eye pain (1%), and dysguesia (1%). Preceding viral infection was present in 49% of patients. 26% of patients were treated with steroid alone, and 74% of cases were treated with steroid plus acyclovir. Oriental medicine was accompanied in 14% of patients. Among 49 patients who were followed over 4 weeks, 44(90%) had complete recovery. The recovery rates were 68% (4 weeks), 91% (3months), and 100% (10 months). Recurrent rate was 4%. CONCLUSION: The prognosis of Bell palsy in pediatric population was good, and recovery rates were 68% within 4 weeks, and 100% by 10 months after palsy onset.
Academic Medical Centers ; Acyclovir ; Adolescent* ; Adult ; Bell Palsy* ; Child* ; Daegu ; Eye Pain ; Facial Nerve ; Facial Paralysis ; Female ; Humans ; Incidence ; Male ; Medical Records ; Medicine, East Asian Traditional ; Paralysis ; Prognosis ; Retrospective Studies ; Seasons

On December 3, 2014, a type O foot-and-mouth disease (FMD) outbreak began in Korea. Although vaccinations were administered, FMD cases increased steadily for five months, and reached 185 cases by April 2015. Most of the affected animals were pigs, which are vulnerable to vaccination. The FMD virus belonged to the South-East Asia (SEA) topotype that had been observed three times in Korea between April 2010 and July 2014. However, the FMD virus isolated in December 2014 had a unique feature; that is, partial deletion of the 5′ non-coding region, a deletion not seen in previous SEA topotype isolates identified in Korea. We conclude that this outbreak included the introduction of a new FMD strain to Korea, and that Korea was now affected by genetically similar FMD virus strains that are related to those from neighboring countries.
Animals ; Asia ; Foot-and-Mouth Disease ; Korea ; Swine ; Vaccination

PURPOSE: Urinary tract infection (UTI) is the most common serious bacterial infection in infants younger than 3 months of age. Lumbar puncture is routinely performed to evaluate febrile young infants for sepsis. However, there is no clear consensus on the use of routine lumbar puncture to diagnose concomitant meningitis in infants with UTI. We evaluated the prevalence of coexisting bacterial meningitis and sterile cerebrospinal fluid (CSF) pleocytosis in young infants with UTI. METHODS: We retrospectively reviewed the medical records of 85 infants with UTI, aged from 29 to 99 days, who were admitted to Daegu Catholic University Medical Center from January 2013 to May 2016. We included 80 patients who had undergone lumbar puncture. Demographic features, clinical features, and laboratory findings were analyzed. Patients were divided into two groups based on the presence of sterile CSF pleocytosis and we compared these groups and assessed the differences between them. RESULTS: Of the 80 UTI patients enrolled, 34 (43%) had sterile CSF pleocytosis. None had bacterial meningitis, and CSF polymerase chain reaction for enterovirus was positive in two patients without CSF pleocytosis. There were no significant differences between the two groups with regards to age, body temperature, peripheral white blood cell count, urinalysis, and duration of hospital stay. CONCLUSIONS: Though sterile CSF pleocytosis is common in young UTI patients, coexisting bacterial or viral meningitis is very rare. Indications for lumbar puncture in these patients depend on clinical condition.
Academic Medical Centers ; Bacterial Infections ; Body Temperature ; Cerebrospinal Fluid ; Consensus ; Daegu ; Enterovirus ; Humans ; Infant* ; Length of Stay ; Leukocyte Count ; Leukocytosis ; Medical Records ; Meningitis ; Meningitis, Bacterial ; Meningitis, Viral ; Polymerase Chain Reaction ; Prevalence ; Retrospective Studies ; Sepsis ; Spinal Puncture* ; Urinalysis ; Urinary Tract Infections* ; Urinary Tract*

Pseudoparalysis is defined as immobility of the extremity due to painful limb infection. However, such conditions may be misdiagnosed as nerve palsy when abnormal neurologic findings are present. We report herein a case with femoral osteomyelitis that was misdiagnosed as lumbosacral plexitis. A 7-month-old male infant was brought by his parents to the clinic who noticed that he did not move his left leg since 4 days prior to admission. Four days prior to admission, the parents noticed that he was not moving his left leg. There were no signs of inflammation in the involved limb. The left leg showed a motor weakness with grade 4/5, and it was hypotonic with decreased deep tendon reflexes. No abnormal findings were shown in studies which included lumbar spine magnetic resonance imaging (MRI), abdominal computed tomography (CT), and nerve conduction studies. Lumbosacral plexitis was diagnosed presumptively and intravenous immunoglobulin (IVIG) was given. The patient's symptom did not improve with the IVIG. After the orthopedic consultation, a hip MRI was performed and it showed acute osteomyelitis involving the proximal metaphysis of the left femur. Surgical debridement and intravenous antibiotics were administered. The patient's symptoms improved with treatment and he was fully recovered by the time of discharge. During the 4-year follow-up, the patient is doing well without any complication in the bone growth. During infancy, limb infection may present with nerve palsy that is characterized by hypotonic weakness with hyporeflexia. Pseudoparalysis may be the sole sign of osteomyelitis. In a unilateral limb weakness, musculoskeletal infection should be an initial diagnosis of exclusion with a thorough evaluation.
Anti-Bacterial Agents ; Bone Development ; Debridement ; Diagnosis ; Extremities ; Femur ; Follow-Up Studies ; Hip ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Infant* ; Inflammation ; Leg ; Magnetic Resonance Imaging ; Male ; Neural Conduction ; Neurologic Manifestations ; Orthopedics ; Osteomyelitis* ; Paralysis ; Parents ; Reflex, Abnormal ; Reflex, Stretch ; Spine

Pseudoparalysis is defined as immobility of the extremity due to painful limb infection. However, such conditions may be misdiagnosed as nerve palsy when abnormal neurologic findings are present. We report herein a case with femoral osteomyelitis that was misdiagnosed as lumbosacral plexitis. A 7-month-old male infant was brought by his parents to the clinic who noticed that he did not move his left leg since 4 days prior to admission. Four days prior to admission, the parents noticed that he was not moving his left leg. There were no signs of inflammation in the involved limb. The left leg showed a motor weakness with grade 4/5, and it was hypotonic with decreased deep tendon reflexes. No abnormal findings were shown in studies which included lumbar spine magnetic resonance imaging (MRI), abdominal computed tomography (CT), and nerve conduction studies. Lumbosacral plexitis was diagnosed presumptively and intravenous immunoglobulin (IVIG) was given. The patient's symptom did not improve with the IVIG. After the orthopedic consultation, a hip MRI was performed and it showed acute osteomyelitis involving the proximal metaphysis of the left femur. Surgical debridement and intravenous antibiotics were administered. The patient's symptoms improved with treatment and he was fully recovered by the time of discharge. During the 4-year follow-up, the patient is doing well without any complication in the bone growth. During infancy, limb infection may present with nerve palsy that is characterized by hypotonic weakness with hyporeflexia. Pseudoparalysis may be the sole sign of osteomyelitis. In a unilateral limb weakness, musculoskeletal infection should be an initial diagnosis of exclusion with a thorough evaluation.
Anti-Bacterial Agents ; Bone Development ; Debridement ; Diagnosis ; Extremities ; Femur ; Follow-Up Studies ; Hip ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Infant* ; Inflammation ; Leg ; Magnetic Resonance Imaging ; Male ; Neural Conduction ; Neurologic Manifestations ; Orthopedics ; Osteomyelitis* ; Paralysis ; Parents ; Reflex, Abnormal ; Reflex, Stretch ; Spine

Guillain-Barré syndrome (GBS) is characterized by ascending symmetric paralysis, paresthesia, and autonomic dysfunction. Autonomic dysfunctions develop in two-thirds of the patients, and urinary retention and paralytic ileus usually develop in severe and advanced cases. There has been no pediatric case with paralytic ileus as a presenting symptom of GBS. Reported herein is a case of GBS presenting vomiting as an initial symptom. A 28-month-old girl was brought to the emergency room due to a 2-day history of vomiting. She vomited multiple times 1 day before the visit, and had only single voiding on admission day. Her abdomen was distended, with decreased bowel sound. Intravenous fluid was given under the diagnosis with acute gastroenteritis with dehydration. The abdominal computed tomography revealed severe paralytic ileus and urinary bladder distention. After having two seizures, she developed respiratory failure necessitating ventilator care. On day 8 after admission, motor weakness with areflexia was noticed. The cerebrospinal fluid analysis showed elevated proteins (80 mg/dL) with no white blood cells (0/mm³). The nerve conduction study showed axonal-type peripheral polyneuropathy. GBS was diagnosed. During the follow-up, the patient was found to have motor weakness in the lower extremities. Paralytic ileus with protracted vomiting can be an initial presentation of GBS in children. Autonomic dysfunction with GBS can be considered in a differential diagnosis in vomiting patients with unclear etiologies.
Abdomen ; Cerebrospinal Fluid ; Child* ; Child, Preschool ; Dehydration ; Diagnosis ; Diagnosis, Differential ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Gastroenteritis ; Guillain-Barre Syndrome* ; Humans ; Ileus ; Intestinal Pseudo-Obstruction* ; Leukocytes ; Lower Extremity ; Neural Conduction ; Paralysis ; Paresthesia ; Polyneuropathies ; Respiratory Insufficiency ; Seizures ; Urinary Bladder ; Urinary Retention ; Ventilators, Mechanical ; Vomiting