Developmental medicine and child neurology
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Dev Med Child Neurol · Oct 1992
Does computed tomography have a role in the evaluation of complicated acute bacterial meningitis in childhood?
The authors examined the records of 30 children with bacterial meningitis to review the role of computed tomography (CT) of the brain in acute management of the disease. CT was normal for 10 patients, six of whom had clinical evidence of raised ICP. ⋯ This study shows that the management of bacterial meningitis is influenced by CT in only a minority of cases; for patients with clinical signs of raised ICP, it was found to be insensitive in confirming the clinical diagnosis and establishing an underlying cause. However, CT remains valuable in the management of children with progressive neurological signs for whom neurosurgical intervention may be necessary.
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Dev Med Child Neurol · Jun 1992
Case ReportsConvulsions with fever as a presenting feature of bacterial meningitis among preschool children in developing countries.
The authors report 522 infants and young children aged between one month and six years who presented with convulsions and fever as emergencies in Nigeria. 22 had bacterial meningitis, six of whom lacked the usual signs of meningitis. Although features of complex febrile convulsions were significantly associated with bacterial meningitis, it is concluded that, as an aid to the early diagnosis of bacterial meningitis, all preschool children convulsing with fever in developing countries should have a lumbar puncture. This may reduce the contribution of meningitis to chronic neurological disabilities. The necessity for such a policy is illustrated by a case report of a young infant with convulsions and fever caused by meningitis, seen at a general hospital.
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Dev Med Child Neurol · Apr 1992
Paediatricians' practice in disclosure and follow-up of severe physical disability in young children.
Twenty-four paediatricians were asked about their policy and practice regarding disclosure and follow-up of the diagnosis of disability, and for suggestions to improve current practice. Doctors with less clinical experience were more likely to mention the presence of the child as an element of the disclosure interview, and scored higher than those with more experience on an index score of the format of the disclosure interview. Paediatricians' reported constraints on their preferred practice and findings from interviews with mothers in the same study confirmed continuing shortcomings in disclosure practice. Changes in medical training, the adoption of a written policy of good practice and the nomination of a 'key worker' for each family are suggested.