Journal of child neurology
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Corticosteroids have been the mainstay for management of cerebral edema caused by leaky angiogenic vessels associated with high-grade brain tumors since the early 1960s. Chronic corticosteroid use can cause iatrogenic Cushing syndrome, which is associated with weight gain and abdominal striae (striae distensae). ⋯ We report the first pediatric case of a 14-year-old boy with corticosteroid-induced abdominal striae who developed ulceration and dehiscence of the striae following the introduction of bevacizumab therapy. The combination of high-dose corticosteroids and anti-vascular endothelial growth factor therapy may cause significant complications, especially in children who are susceptible to abdominal striae and therefore should be avoided.
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Acute intermittent porphyria is a metabolic disorder rarely seen in prepubertal children. A delay in diagnosis of acute intermittent porphyria is common because of variable and nonspecific symptoms. We report an 8-year-old boy with right hemimegalencephaly and intractable seizures, who presented with dark-colored urine, hypertension, increasing lethargy, fluctuating seizures, and poor oral intake. ⋯ His antiepileptic medications were discontinued and hemin administered, with dramatic clinical improvement. The diagnosis of acute intermittent porphyria was challenging because of his underlying neurologic condition. This case highlights the variable presentation of acute intermittent porphyria and emphasizes the importance of considering the diagnosis even in young patients with underlying neurologic conditions when they present with nonspecific neurovisceral symptoms or with unexplained neurologic deterioration.
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Economic factors play an increasingly important role in the management of medical conditions. This study evaluated the economic impact of seizures in children in the United States using a large national data set known as the Kids' Inpatient Database (KID). The aim of this study was to characterize hospitalizations including total costs, length of stay, and variations in care. ⋯ Patients with government insurance as the primary payer had a significantly longer length of stay compared with private insurance or self-pay patients (P < .0001); however, there was no significant difference in the total costs of hospitalization between the different payer groups. This analysis highlights multiple disparities of health care utilization in pediatric seizure management. In a stressful economic climate, all health care entities must focus on cost management of pediatric seizure.