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Research on Related Factors of Children Repeated Headache After the Recovery of Episodes Viral Encephalitis

Author: TangXiaoNa
Tutor: GuoZhuoPing
School: Hebei Medical University
Course: Pediatrics
Keywords: after the recovery of episodes viral encephalitis headache mycoplasma pneumonia antibody platelet high sensitivity C reactive protein electroencephalogram
CLC: R725.1
Type: Master's thesis
Year: 2012
Downloads: 46
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Abstract


Objective: In recent years, the morbidity of the headache after therecovery of episodes viral encephalitis is increasing, which greatly influenceson children’s study and quality of life. And clinicians have difficulty indiagnosing and dealing with it. At present, a large amount of the medical unitsstill use antibiotics as one of clinical treatment methods. Through measuringthe changes of mycoplasma pneumoniae antibody (MP-IgM), platelet count(PLT), mean platelet volume (MPV), high sensitivity C reactiveprotein(hsCRP) and electroencephalogram (EEG), Transcranial DopplerSONARA detection of the repeated headache children after the recovery ofepisodes viral encephalitis. we will analyze and evaluate the differencesamong indexes as well as their relativities, then make a further study of thediagnosis and treatment methods of the repeated headache.Methods: We study the children who suffered repeated headache afterthe recovery of episodes viral encephalitis from outpatient on neurologyspecialty of pediatric in our hospital from May2010to December2011, wechoose112cases as object. The diagnostic criteria[1]for virus encephalitis areaccorded on the fifth edition textbook of Pediatrics. Headache is diagnosedthrough the International Headache Society (IHS) classification anddiagnostic criteria (1988)[2], is a secondary headache. While we choose30cases who couldn’t concentrate and had a hyperactivity tendency without viralencephalitis history as control group with age and sex matched. The criteriafor an experimental group to take part in:(1) the brain CT, MRI normal(except organic trauma)(2) nervous system development is normal. Withoutblood system diseases.(3) nearly a month without a clear infectious diseases(except sinusitis and fever etc.). All the children were collected venous blood4ml into chilled tubes containing EDTA, then we immediately measure the parameters of platelet—PLT and MPV by the automated blood cellanalyzer.While take2ml venous blood centrifuged for blood serum to detectmycoplasma pneumoniae antibody(MP-IgM) through reagent box(SERODIA-MYCO II)which were provided by FUJIREBIO INC. All thechildren were collected peripheral blood, and were detected C reactive proteinusing reagent box that were applied by Bodi Tech Med, Korea Inc. All thechildren did the video electroencephalogram using the Bio-Logic systemsCORP CEEGRAPH VISION EEG. We detect blood flow velocity ofintracranial vascular of37children in experimental group through full digitalcolor Transcranial Doppler SONARA which were provided by VIASYScompany. All statistical analysis was preceded by the application of SPSS13.0statistic software. The data was divided into measurement data and count databy its nature. While median (inter-quartile range)(M(Q))were used to depictthe measurement data with skewed distribution, the comparison between twogroups by nonparametric test (Mann-Whitne U test), count data usechi-square test. Spearman’s correlation was used to test the associationbetween two variables with a skewed distribution. In our study we assesscorrelation between hsCRP and MP-IgM, hsCRP and PLT. The significancelevel was set at P<0.05.Results:1.The comparison of MP-IgM between the experimental group and the controlgroupThere were52cases positive(46.43%)of the112cases, while60casesnegative (53.57%) in experimental group. There were2cases positive (6.7%)of the30cases, while28cases negative (93.3%) in control group. Thepositive rate of MP-IgM in experimental group was significantly higher thanthat of control group. X2=14.232, P<0.05, there existed significantdifference.(Table1)2.The comparison of PLT between the experimental group and the controlgroupPLT(×109/L) of the112children in experimental group was373.00 (173.25),while PLT of the30cases in control group was205.50(102.00),PLTof the experiment group was significantly higher than that of control group.Comparison between two groups, Z=-6.999, P=0, there existed significantdifference.(Table2)3.The comparison of MPV between the experimental group and the controlgroupMPV(fl)of the112children in experimental group was6.50(0.90),while MPV of the30cases in control group was8.75(1.28),. MPV of theexperiment group was significantly lower than that of control group. Z=-7.535, P=0there existed significant difference.(Table2)4.The comparison of hsCRP between the experimental group and the controlgroup.hsCRP(mg/L) of the112children in experimental group was0.50(2.68), while hsCRP of the30cases in control group was0.50(0.10),there were no significant difference between the experimental group and thecontrol group. Comparison between two groups, Z=-1.326, P=0.059therewere no significant differences.(Table2)5.There were no relativity between hsCRP and MP-IgM in experimentalgroup.(Fig.1) while also hsCRP and PLT had no relativity in experimentalgroup.(Fig.2)6.The comparison of EEG between the experimental group and the controlgroupThere were58(51.79%)cases abnormal EEG of the112cases inexperimental group. The widespread moderate abnormality contained8cases,which were mainly2-4Hz Delta wave. While mild abnormalities contained50cases which were mainly4-6Hz theta wave, in50cases of mild abnormalities,there were34cases of widespread abnormality EEG which were widely4-6Hz theta wave, while14cases showed theta wave in the back of the head,2cases showed detectable spike and slow wave. There was only1case(3.3%)abnormal EEG of the30cases in control group. The abnormal rate of EEG inexperimental group was significantly higher than that of the control group. Comparison between two groups, X2=18.238, P<0.05, there existedsignificant difference.(Table3)7.37of the112cases in experimental group have completed the TranscranialDoppler SONARA examination, only2cases was abnormal.8.The age of112cases in the experiment group was9(4) years old, soindicated the time that most children who had repeated headache after therecovery of episodes viral encephalitis was during their school age.Conclusions:1.Children with repeated headache after recovery of episodes viralencephalitis should be paid attention to the exclusion of mycoplasmapneumoniae infection, so it is necessary to examine MP-IgM.2.The increasing of PLT and MPV changes can be regarded as marks thatreactive increasing and activation of platelet, and they can indicateinflammatory changes in body. While impaired cerebral vascular endothelialcells during the acute phase of children with virus encephalitis were sensitiveto the circulation of PLT, MPV changes, which may induce local immuneinflammation causing repeated headache after the clinical recovery of episodesviral encephalitis in partial children.3. The hsCRP had no significant changes in children’s repeated headache afterthe clinical recovery of episodes viral encephalitis, and had no correlation withthe changes of MP-IgM, PLT that can except bacterial infections. It wasadvantageous to choose anti-platelet aggregation drugs such as non-steroidanti-inflammatory appropriately rather than antibiotic.4.The basic reason causing repeated headache was that injury of nerve cellsfunction which suggested though EEG abnormalities.5.Children repeated headache after the clinical recovery of episodes viralencephalitis have no significance changes through the Transcranial DopplerSONARA examination. All this indicated us that children’s blood dynamics ofbrain vascular was normal and it was different from children’s typical biliousheadache seizure, so Transcranial Doppler SONARA examination can not beregarded as a routine examination on this kind of headache.

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