Pediatric neurology
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Pediatric neurology · Sep 2008
Case ReportsSleep-disordered breathing in Chiari malformation type 1.
Type 1 Chiari malformation is defined as an elongation of the cerebellar tonsils >6 mm below the foramen magnum. Central sleep apnea is a well-recognized sign, and can be an initial presentation, of this malformation. ⋯ Magnetic resonance imaging revealed a Chiari type 1 malformation requiring decompression. We emphasize the importance of including cervicomedullary junction disorders in the differential diagnosis of apnea, and we review the literature concerning mixed apneas and obstructive sleep apneas in Chiari type 1 malformation.
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Children with disabilities require special education and related services that are as diverse as the individual children themselves. Special education is not necessarily a special classroom but a well thought-out program of collaborative interventions leading to educational goals set forth by a multidisciplinary team. ⋯ Pediatricians and pediatric subspecialists are in a unique position to develop a medical home for the disabled child, and in doing so must be well-versed in both case law and federal legislation as it applies to special education, in an effort to be a child's best advocate. A chronological review of case law and federal legislation, including the Individuals with Disabilities Education Act, No Child Left Behind Act, and recent amendments, are discussed, and their relevance to physician practice is detailed.
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Pediatric neurology · Sep 2008
Case ReportsInfant botulism type Ba: first culture-confirmed case in the United Arab Emirates.
We report on a 3-month-old girl with culture-confirmed infant botulism caused by a rare double toxin-producing Clostridium botulinum type Ba. This case was not related to honey-feeding. The clinical course was prolonged, with minimal spontaneous improvement at onset, and a period of fluctuating motor weakness and nasogastric feeding dependence afterward. ⋯ Human botulism immune globulin was administered empirically on day 23 of presentation, with rapid full recovery. This case highlights the importance of pursuing diagnoses of infant botulism despite normal results of neurophysiologic testing and no history of honey-feeding. Our case also demonstrates a favorable response to human botulism immune globulin, despite the relatively late treatment.