Clinical Data Analysis And Follow-up Of 37 Paediatrics Neurologist Difficult Cases

Objective: To retrospectively analyze and follow-up the clinical data of 37 children neurologist difficult cases, to realize the reasons and basic types of occurrence, and development for these cases, to improve the diagnostic level of difficult cases, to further develop clinical diagnostic ideas and provide basis for this kind of diseases.Methods: Thirty-seven children neurologist cases were selected, which were determined as the clinical difficult cases by internal discussion between January 2005 and November 2010. The clinical data was obtained from the full medical records and then telephone follow-up survey with the uncertained ones to acquire the final diagnosis. The cases were divided into diagnosis-supporting, misdiagnosis and no-help in diagnosis groups, based on the variety reasons of occurrence, development and others.Results: Thirty-seven cases included male 19 male and 8 female1cases. The average age was 6.13±6.02 years old, and the average hospitalization time was 14.6±2.65 days. The diseases mainly include infections diseases, regeneration disease and epilepsy. The reasons for difficult cases for discussing were: (1) Unclear or difficult to diagnose, accounting for 44%; (2) Poor therapeutic effect, accounting for 26.5%c; (3) Illness evolution that need establish new diagnosis, accounting for 20.6%; (4) Clinical manifestations and important auxiliary examination with discrepancies, accounting for 8.8%. The reasons for misdiagnose were as follows: (1) Disease is still in the early stages and the typical symptoms were fully revealed, accounting for 31.6%. (2) The cases were excessively dependent on the auxiliary inspections, and the clinical manifestations were neglected and incompatible with these auxiliary inspections, accounting for 21.1%. (3) History data collection were not comprehensive or gathering information were declinational, accounting for 21.1%. (4) The history data was not analysed comprehensively, accounting for 21.1%; (5) The physical examination were not in-depth, accounting for 5.3%. The reasons for difficult diagnosis were: (1) Patients were not cooperated with doctors to complete the significant auxiliary inspections, accounting for 45.5 %. (2) The core facilities of hospital were insufficient, leading to the incompleted auxiliary inspections, accounting for 36.4 %. (3) The compliance of patient was bad and lose follow-up after discharge, accounting for 9.1 %. (4) The asymptomatic or atypical disease were manifested, accounting for 9.1 %. The utilization rate of cerebrospinal fluid (CSF) examination, electrophysiology inspection and imaging examination was 78.3%, 95.7% and 87.0% respectively. The correct diagnosis rate was 50.0%, 68.2% and 55% respectively. The wrong diagnosis rate was 5.6%, 9.1% and 5.0% respectively.Conclusions: Most difficult cases of pediatric neurologist diagnosis has difficulty. It is necessary and key to discuss difficult cases for clinical work. The difficult cases mainly include infection diseases, regeneration disease and epilepsy. In the process of diagnosing difficult cases, we should collect and analysis history comprehensively, perform physical examination in-depth. We should combine the clinical manifestations, syptoms analysis with the key auxiliary examinations to evaluate the results. We should also communicate with patients actively and effectively, and cooperate with related departments and organiza consultation actively. All this together is to improve the diagnostic accuracy and treatment effect for children neurologist difficult cases. Objective: To explore the clinical characteristics, treatment effect and prognosis of childhood alternating hemiplegia.Methods: Retrospectively analyzed the clinical manifestations, auxiliary inspections, curative effect and prognosis of 2 children alternating hemiplega in recent literatures.Results: Neither the two patients were found the certain pathogeny. These two patients both were onset less than l8 months old. The clinical symptoms were repeated hemiplegia attacks of one side or two sides. Both had myodystonia or myodystony. The results of EEG and MRI are both negative. Both of them were improved after cure by flunarizine.Conclusions: Alternating hemiplegia of childhood is agnogenic and rare disease,which is chronic and progress , typical course of disease divide to 3 phases. Its clinical characteristics includes onset less than l8 months old, repeated hemiplegia at unilateral or bilateral limbs, which was accompanied by other onset symptoms and dysgnosia. The results of EEG and MRI are often negative. Most of this kind of patients are effectively treated by flunarizine.