Akut Güçsüz Çocuğa Yaklaşım
Özet
Çocuklarda akut güçsüzlük, hızlı ve dikkatli bir klinik değerlendirme gerektiren önemli bir nörolojik acil durumdur. Güçsüzlüğün kaynağını birinci motor nöron veya motor ünite hastalıkları arasında ayrıştırmak, doğru teşhis ve tedavi süreci için temeldir. Solunum ve kardiyovasküler sistemin stabilizasyonu ilk öncelik olmalı; erken teşhis ise hastanın prognozu üzerinde kritik bir role sahiptir. Ayrıntılı öykü ve nörolojik muayene, etiyolojik nedenlerin saptanmasında en belirleyici araçlardır.
Acute muscle weakness in children is a neurological emergency that necessitates a rapid and meticulous clinical assessment. Distinguishing whether symptoms originate from upper motor neuron or motor unit disorders is essential for directing diagnostic and therapeutic strategies. Stabilization of respiratory and cardiovascular functions must be the primary priority, while early diagnosis plays a critical role in patient prognosis. A comprehensive medical history and neurological examination are the fundamental tools for identifying underlying etiologies.
Referanslar
Garza JEP, James KC, Flaccid Limb Weakness in Childhood, Fenichel’s Clinical Pediatric Neurology A Signs and Symptoms Approach, 8th edition. United States of America Philadelphia: Elsevier. 2019; p 190-97.
Konersman C, Hypotonia, Weakness, and Stroke, Kliegman RM, Lye PS editors, Nelson Pediatric Symptom-Based Diagnosis, United States of America Philadelphia, Elsevier. 2018 p455-497.
Oostvogel PM, Spaendonck MA, Hirasing RA, van Loon AM. Surveillance of acute flaccid paralysis in The Netherlands, 1992-94. Bull World Health Organ. 1998;76(1):55-62.
Morgan L. The Child With Acute Weakness. Clin Pediatr Emerg Med 2015;16(1):19-28.
Singhi SC, Sankhyan N, Shah R, Singhi P. Approach to a child with acute flaccid paralysis. Indian J Pediatr. 2012;79(10):1351-1357.
Marx A, Glass JD, Sutter RW. Differential diagnosis of acute flaccid paralysis and its role in poliomyelitis surveillance. Epidemiol Rev. 2000;22:298–316.
Medical Research Council. Aids to the examination of the peripheral nervous system. London: Her Majesty’s Stationery Office; 1981. (Memorandum, Nº 45).
Torricelli RPJE. Acute muscular weakness in children. Arq Neuropsiquiatr. 2017;75(4):248-254.
Tenembaum S. Acute disseminated encephalomyelitis. In: Dulac O, Lassonde M, Sarnat HB, editors. Pediatric neurology Part II. Amsterdam: Elsevier; 2013. p. 1255-62. (Handbook of clinical neurology, Vol 112).
Kahn I. Acute Transverse Myelitis and Acute Disseminated Encephalomyelitis. Pediatr Rev. 2020 Jul;41(7):313-320.
Santoro JD, Lazzareschi DV, Campen CJ, Van Haren KP. Pediatric Bickerstaff brainstem encephalitis: a systematic review of literature and case series. J Neurol. 2018 Jan;265(1):141-150.
Murphy OC, Messacar K, Benson L, et al. Acute flaccid myelitis: cause, diagnosis, and management. Lancet. 2021;397(10271):334-346.
Rolak LA, Rutecki P, Ashizawa T, Harati Y. Clinical features of Todd's post-epileptic paralysis. J Neurol Neurosurg Psychiatry 1992; 55(1):63-4.
Headache Classification Committee of the International Headache Society (IHS).The International Classification of Headache Disorders, 3rd edition (beta version) Cephalalgia 2013;33(9):629-808.
Vasconcelos MM, Vasconcelos LGA, Brito AR. Assessment of acute motor deficit in the pediatric emergency room. J Pediatr (Rio J) 2017;93(s1):26-35.
Wilne S, Collier J, Kennedy C, Koller K, Grundy R, Walker D. Presentation of childhood CNS tumours: a systematic review and meta-analysis. Lancet Oncol. 2007 Aug;8(8):685-95.
Korukluoglu G, Ozdemirer U, Bayrakdar F, et al. Detection of non-polio and polio enteroviruses in Acute Flaccid Paralysis surveillance in Turkey [published online ahead of print, 2021 Mar 1]. Acta Microbiol Immunol Hung. 2021;10.
Gülcü S, Arslan S. Çocuklarda Aşı Uygulamaları: Güncel Bir Gözden Geçirme. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi. 2018; 8(1): 34-43.
Reynolds T. Polio: an end in sight? BMJ. 2007;335(7625):852-4.
Jasem JA, Marof K, Nawar A, Khalaf I, Al-Hamdani S, Ali A et al. Surveillance of acute flaccid paralysis in Iraq: 1998 to 2011. BMC Infect Dis. 2014;11(3):164-73.
Huang CC, Liu CC, Chang YC, Chen CY, Wang ST, Yeh TF. Neurologic complications in children with enterovirus 71 infection. N Engl J Med. 1999;341(13):936-42.
Wolbert JG, Higginbotham K. Poliomyelitis. 2020 Jun 22. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.
Sladky JT. Guillain-Barré syndrome. In: Jones HR Jr, De Vivo DH, Darras BT, editors. Neuromuscular disorders of infancy, childhood and adolescente: a clinical approach. Oxford: Butterworth Heinemann; 2003. p. 407-44.
Korinthenberg R. Acute polyradiculoneuritis: Guillain-Barré syndrome. Handb Clin Neurol. 2013;112:1157-62.
Asbury AK. Diagnostic considerations in Guillain‐Barré syndrome. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society. 1981;9(S1):1-5.
Malek E, Salameh J. Guillain-Barre Syndrome. Semin Neurol. 2019 Oct;39(5):589-595.
Herrick AL, McColl KE. Acute intermittent porphyria. Best Pract Res Clin Gastroenterol. 2005 Apr;19(2):235-49.
Keka A, Ramosaj A, Toro H, Azemi M, Baloku A, Sylaj B et al. Acute poisoning in children: changes over the years, data of pediatric clinic department of toxicology. J Acute Dis. 2014;3(1):56-8.
Shobha N, Taly AB, Sinha S, Venkatesh T. Radial neuropathy due to occupational lead exposure: Phenotypic and electrophysiological characteristics of five patients. Ann Indian Acad Neurol. 2009 Apr;12(2):111-5.
Kukreti V, Shamim M, Khilnani P. Intensive care unit acquired weakness in children: critical illness polyneuropathy and myopathy. Indian J Crit Care Med. 2014;18(2): 95-101.
Berkowitz AL. Tetanus, Botulism, and Diphtheria. Continuum (Minneap Minn). 2018 Oct;24(5, Neuroinfectious Disease):1459-1488.
Pickett J, Berg B, Chaplin E, Brunstetter-Shafer MA. Syndrome of botulism in infancy: clinical and electrophysiologic study. N Engl J Med. 1976;295(14):770-2.
Gothe R, Kunze K, Hoogstraal H. The mechanisms of pathogenicity in the tick paralyses. J Med Entomol. 1979;16(5):357-69.
Altay K , Şahin Ö . Kene Felci (Etiyoloji, Epidemiyoloji, Patofizyoloji, Klinik Tablo, Teşhis, Tedavi ve Korunma). Turkish Veterinary Journal. 2020; 2(1): 17-23.
Naughton SX, Terry AV Jr. Neurotoxicity in acute and repeated organophosphate exposure. Toxicology. 2018;408:101-112.
Öztoprak Ü , Energin V . Çocuk Acil Servisine Zehirlenme Nedeniyle Başvuran Olguların Değerlendirilmesi. J Contemp Med. 2020; 10(4): 585-590.
Szobor A, Máttyus A, Molnár J. Myasthenia gravis in childhood and adolescence. Report on 209 patients and review of the literature. Acta Paediatr Hung. 1988;29(3-4):299-312.
Wendell LC, Levine JM. Myasthenic crisis. Neurohospitalist .2011;1(1):16-22.
Brisca G, Mariani M, Pirlo D, et al. Management and outcome of benign acute childhood myositis in pediatric emergency department. Ital J Pediatr. 2021;47(1):57.
Findlay AR, Goyal NA, Mozaffar T. An overview of polymyositis and dermatomyositis. Muscle Nerve. 2015 May;51(5):638-56.
Statland JM, Fontaine B, Hanna MG, et al. Review of the Diagnosis and Treatment of Periodic Paralysis. Muscle Nerve. 2018;57(4):522-530.
