Progression from first symptom to diagnosis in childhood brain tumours

This study was undertaken to investigate the evolution of clinical features between onset of symptoms and diagnosis in children with brain tumours and to identify ways of shortening the time to diagnosis. One hundred and thirty-nine children with a brain tumour were recruited from four UK paediatric neuro-oncology centres. Children had a median of one symptom or sign at symptom onset and six by diagnosis. The symptoms and/or signs experienced at symptom onset and at diagnosis were as follows: headache in 55 and 81 children, nausea and vomiting in 39 and 88 children, motor system abnormalities in 31 and 93 children, cranial nerve palsies in 24 and 75 children, visual system abnormalities in 23 and 96 children, endocrine or growth abnormalities in 10 and 35 children and behavioural change in 4 and 55 children. The median time between symptom onset and diagnosis (symptom interval) was 3.3 months. A longer symptom interval was associated with head tilt, cranial nerve palsies, endocrine and growth abnormalities and reduced visual acuity. More than half of children with brain tumours developed problems with vision and more than a third developed motor problems, cranial nerve palsies, behavioural change, or nausea and vomiting between symptom onset and diagnosis.     

Delay in the diagnosis of paediatric brain tumours

The pre-diagnostic period of 252 children (median age 6.3 years, range 0-16.9 years) with primary brain tumours was assessed to analyse their clinical presentation and reasons for any delay in diagnosis. The median pre-diagnostic symptomatic interval (PSI) was 60 days (range 0-3010 days) with a parental delay of 14 days (range 0-2310 days) and a doctor's delay of 30 days (range 0-3010 days). Only 33% of brain tumours were diagnosed within the 1st month after the onset of signs/symptoms. PSI correlated significantly with patients' age and tumour histology, but not with gender, year of diagnosis or tumour location (supratentorial hemispheric, supratentorial midline, infratentorial). In children older than 2 years, most common initial signs/symptoms were headache, nausea/vomiting, seizures, squint/diplopia, ataxia and behavioural changes. In children younger than 2 years, most common initial signs/symptoms were seizures, vomiting, head tilt and behavioural changes. These signs/symptoms are by no means pathognomonic features of brain tumours, making the diagnosis in the early course often difficult. CONCLUSION: given the fact that the vast majority of patients (88% in the present study) develop further signs/symptoms, a high level of awareness, a detailed medical history and repeated correctly interpreted neurological examinations should lead to an earlier diagnosis and to a higher probability of total tumour resection.     

Lyme neuroborreliosis in pediatrics: A retrospective,descriptive study in southwest France

BackgroundThe neurological effects of Lyme borreliosis in children are varied and their clinical progression is not widely reported in the French literature. We carried out a retrospective study to describe the clinical characteristics of Lyme neuroborreliosis in children in southwest France and their clinical progression at 6 months.MethodsThis study was carried out at Toulouse University Hospital during the period 2006–2017 using patient records. Case definition was based on the combined French clinical and laboratory diagnostic criteria.ResultsIn total, 26 children were included. The median age was 8 years (4–14 years). The different neurological symptoms reported were: meningoradiculitis (62%), which was usually associated with facial palsy (54%); isolated facial palsy (15%); isolated meningitis (8%); polyradiculoneuritis (4%); benign intracranial hypertension (4%) and myelomeningoradiculitis (4%). The most common functional symptoms were headaches (54%), the perception of asthenia (42%), neck pain (27%), and a loss of appetite (19%). Patients with laboratory meningitis (84%) often had no signs of meningism or headaches (38%).ConclusionThe majority of the cases involved meningoradiculitis but other, less common, neurological conditions have been described. The clinical signs suggestive of meningitis are not very marked and might delay the diagnosis.     

The presenting features of brain tumours: a review of 200 cases.

OBJECTIVE: To determine the presenting features of brain tumours in children. DESIGN: Retrospective case note review. SETTING: Paediatric and neurosurgical services at the Wessex Neurology Centre and Southampton General Hospital, UK. Patients: 200 patients presenting with a CNS tumour between 1988 and 2001. RESULTS: The commonest first presenting symptoms were headache (41%), vomiting (12%), unsteadiness (11%), visual difficulties (10%), educational or behavioural problems (10%), and seizures (9%). The commonest symptoms occurring at any time were headache (56%), vomiting (51%), educational or behavioural problems (44%), unsteadiness (40%), and visual difficulties (38%). Neurological signs were present at diagnosis in 88%: 38% had papilloedema, 49% cranial nerve abnormalities, 48% cerebellar signs, 27% long tract signs, 11% somatosensory abnormalities, and 12% a reduced level of consciousness. The median symptom interval was 2.5 months (range 1 day to 120 months). A short symptom interval was significantly associated with high grade tumours and patient age of 3 years or younger. CONCLUSIONS: The well known predominance of headache in children with CNS tumours is confirmed. Visual, behavioural, and educational symptoms were also prominent. With the exception of seizures, every initial symptom was accompanied by other symptoms or signs by the time of diagnosis. Questions about visual symptoms and educational or behavioural difficulties, as well as the more widely recognised symptoms of raised intracranial pressure and motor dysfunction, are important in the diagnosis of brain tumours, as are vision assessment and the appropriate plotting of growth and head size.     

Why are brain tumours still being missed?

The prediagnosis period of 74 children with primary brain tumours was assessed to examine their presentation and reasons for any delay in diagnosis. Medical case notes were reviewed and parents were interviewed and asked to complete psychological questionnaires. Mean (SD) duration of clinical history was 20.0 (29.1) weeks. Most common symptoms were vomiting (65%) and headache (64%). Only 34% of headaches were always associated with vomiting and only 28% occurred 'early morning'. Changes in the child's personality (47%) were also common. The average number of consultations before diagnosis was 4.6. Migraine was diagnosed in 24% of children and a psychological aetiology in 15%. One quarter of the children had altered levels of consciousness on arrival at the unit. Results indicate that delay in diagnosis still occurs, despite strong parental concern. The nonspecificity of symptoms and a high incidence of psychological symptoms may confound the clinical picture and are considered along with other possible contributory factors.     

儿童甲型流感并发神经系统症状的临床研究

目的 了解儿童甲型流感(简称甲流)并发神经系统症状的临床特点.方法 回顾性分析2019年1～12月西安交通大学附属西安市儿童医院经实验室确诊为甲流,且伴有神经系统症状患儿的临床资料.结果 共有895名患儿确诊为甲流.291例(32.5％)并发神经系统症状,男孩发生率高于女孩(P<0.05),幼儿期发生率高于其他年龄组(...     

Appendicitis in children less than 3 years of age: a 28-year review

Appendicitis is the most common surgical abdominal emergency in the pediatric population, but is rarely considered in children less than 3 years of age. The goal of this study was to identify the presenting symptoms and signs in this age group and examine their subsequent management and outcome. A 28-year experience of a single pediatric surgeon in academic practice was reviewed; 27 children less than 3 years old (mean 23 months) comprised 2.3% of all children with appendicitis in his series. The most common presenting symptoms were vomiting (27), fever (23), pain (21), anorexia (15), and diarrhea (11). The average duration of symptoms was 3 days, with 4 or more days in 9 children. Eighteen children were seen by a physician before the correct diagnosis was made; 14 were initially treated for an upper respiratory tract infection, otitis media, or a urinary tract infection. The most common presenting signs were abdominal tenderness (27), peritonitis (24), temperature 38.0 °C or more (21), abdominal distension (18), Leukocytosis (<12.0 × 10³/mm³) was found in 18, tenderness was localized to the right lower quadrant (RLQ) in 14 and was diffuse in 10. Abdominal radiographs demonstrated findings of a small-bowel obstruction (SBO) in 14 of 21 patients, a fecalith in 2, and a pneumoperitoneum in 1. Contrast enemas were performed in 6 children, 5 of whom had a phlegmon or an abscess. Perforated appendicitis was found in all 27 patients. An appendectomy was performed in 25 and a RLQ drain was placed in 18. Postoperative antibiotics were administered to 17 children for an average of 6 days. Two patients underwent interval appendectomies, 1 following treatment with IV antibiotics and 1 following surgical drainage. The average time to resume oral intake was 7 days and the average hospital stay was 21 (median 15) days. Sixteen patients had 22 complications, which included 6 wound infections, 4 abscesses, 4 wound dehiscences, 3 pneumonias, 2 SBOs, 2 incisional hernias, and 1 enterocutaneous fistula. Perforated appendicitis was found in all children less than 3 years old, resulting in very high morbidity (59% complications), which may be attributed to the 3–5-day delay in diagnosis. Although appendicitis is uncommon in this age group, it should be seriously considered in the differential diagnosis of children under the age of 3 years who present with the triad of abdominal pain, tenderness, and vomiting.     

Outcome for children with cyclical vomiting syndrome.

OBJECTIVE: Cyclical vomiting syndrome (CVS) is a disorder that carries a significant burden of disease for children and their families. The aim of this study was to examine the outcome of a group of children diagnosed with CVS from 1993 to 2003. METHODS: Children diagnosed with CVS over a 10-year period were identified and a review of the clinical records was carried out to define demographic features and the spectrum of disease at presentation. The patient's parent was contacted to establish the child's current well-being. Ethical approval for the study was obtained. RESULTS: Fifty one children were diagnosed with CVS and 41 agreed to participate in follow-up. Mean age was 5.8 (SD 3.3) years at onset of CVS, 8.2 (SD 3.5) years at diagnosis, and 12.8 (SD 4.8) years at follow-up. Vomiting had resolved at the time of follow-up in 25/41 (61%) children. Sixteen of 41 (39%) children reported resolution of symptoms either immediately or within weeks of diagnosis. However, a large number of children from the group whose vomiting resolved and the group that were still vomiting continued to have somatic symptoms, with 42% of children suffering regular headaches and 37% having abdominal pain. 32 (78%) parents felt that the provision of a positive diagnosis and information made a significant impact on the severity of vomiting. CONCLUSIONS: While 60% of children with CVS have resolution of symptoms, a significant proportion of both those in whom symptoms have resolved and those in whom vomiting persists continue to suffer from other somatic symptoms.     

儿童周期性呕吐综合征临床特征及预后随访

目的　分析儿童周期性呕吐综合征（CVS）临床表现、辅助检查、治疗及预后,以期提高对儿童周期性呕吐综合征的认识和诊治水平。方法　回顾性分析重庆医科大学附属儿童医院消化科2008年1月至2019年12月住院且符合儿童功能性胃肠病ROME Ⅳ诊断标准的141例CVS患儿临床资料及随访结果。结果　141例患儿中男65 例、女76例,发病年龄中位数5.5岁（≤15岁5月龄）,诊断年龄中位数8.3岁（11月龄至15岁8月龄）,首次发病至确诊病程平均2.3年（3个月至11.3年）,平均住院4次。其中60.28%（85/141）有明确诱因,感染与饮食不当最常见。所有病例均有呕吐,发作持续时间中位数为5 d（2～14 d）,平均每日呕吐发作约15次,间歇期中位数38 d（5 d至6 个月）。其他症状包括腹痛（72.34%,102/141）、恶心（46.81%,66/141）、头晕（30.50%,43/141）、发热（26.24%,37/141）、头痛（19.86%,28/141）、便秘（19.15%,27/141）。所有病例急性期均予以补液等对症支持治疗,发作间期予以赛庚啶、普萘洛尔、西比灵等药物预防治疗,88例随访1~10年,81例（92%）治疗有效,9例仍有头痛表现（其中1例外院诊断偏头痛）,13例有腹痛表现。结论　CVS是儿童呕吐的常见病因之一,各年龄段均可发病,无明显性别差异,发作前通常有诱因且临床诊断常有延迟;CVS可反复发作,除呕吐外常有其他消化道或自主神经紊乱相关症状;对于发作频率高、持续时间长的患儿预防应用赛庚啶、普萘洛尔、西比灵等药物多数有效;该组CVS患儿流行病学、临床表现及疗效与其他地区相似,但随访偏头痛、腹痛发生率明显低于国外数据。     

Evaluation of vomiting in children

Vomiting is a frequently reported symptom in children and can be a presenting feature in both gastro-intestinal and non gastro-intestinal disease. Careful evaluation of all children with vomiting is essential in order to identify causes which require urgent management. Important aspects of the history include onset, frequency, duration and colour of the vomitus as well as associated gastro-intestinal, respiratory and neurological symptoms. Bilious vomiting at any age should always be taken seriously and any history of recurrent bouts of vomiting is important. A thorough examination is necessary to assess hydration status of the child and elicit other associated features such as congenital abnormalities, failure to thrive or neurological deficit. Definitive management will depend on the underlying cause and may include medical and surgical therapies. In all cases good supportive care is vital with adequate fluid and electrolyte replacement being paramount. ‘Red flag’ symptoms including early morning headache, signs of peritonism, lethargy, bulging fontanelle in infants, and persistent vomiting with poor growth or abnormal development, should point the clinician to the possibility of more sinister causes of vomiting.     

Diagnosis, misdiagnosis, and associated diseases of achalasia in children and adolescents: a twelve-year single center experience

Purpose

Although achalasia is a rare disorder in children, its symptom may mimic common childhood diseases. This study aimed to assess the diagnosis and management of achalasia in children and adolescents in a Brazilian single center during a 12-year period.

Methods

Patients with achalasia were identified from a database built during the period of January 2000?CJanuary 2012 from a Pediatric Gastroenterology reference center. Information regarding demographic data, clinical symptoms, diagnosis, treatment, and long-term follow-up were described.

Results

Thirteen patients were studied; median age was 7 (1?C14)?years. Most frequent symptoms were vomiting (84.6?%) and dysphagia (69.2?%). Weight loss occurred in 46.0?% of patients and chronic cough in 46.1?%. Associated disorders were Down??s syndrome, Allgrove syndrome, and congenital central hypoventilation syndrome. Achalasia was misdiagnosed with anorexia nervosa. Six patients were previously treated as having gastroesophageal reflux disease and asthma. Five patients had pneumatic balloon dilation as initial therapy whereas five had esophageal myotomy. Finally, 11 patients had surgical therapy with a favorable follow-up.

Conclusion

Achalasia symptoms may mimic common diseases in children, and therefore, may delay the diagnosis. This study emphasizes the importance of the clinical symptoms for the diagnosis of achalasia, mainly in those cases with associated disorders.     

Evaluation of varicella complications through a retrospective hospital survey in a paediatric center over 16 years in France]

OBJECTIVE: Evaluation of the varicella severity through a prevalence study of hospital admissions justified by a complication directly related to the onset of an acute episode of varicella. METHODS: Retrospective study in one paediatric center in France with a follow-up of a paediatric cohort from April 1987 to December 2002. This general paediatric hospital recruits children from a 400,000 inhabitants area. Inclusion criterion: diagnosis main or associated of varicella. Exclusion criteria: congenital or acquired immunodepression, including long-term oral high dosage steroid therapy. RESULTS: Three hundred and forty-three (343) complications of varicella were reported in 309 children hospitalised for a symptom in relationship with varicella. Most of children (75%) were <2 years of age. The annual number of hospitalisations varied with a maximum of 44. An increase of the number of hospitalisations was reported since 1997 but particularly since 2000. Main complications were gastro-intestinal (75), neurological (68), bronchopulmonary (52), and skin and soft tissue infections (52). Superinfections of soft tissues such as Streptococcus pyogenes cellulitis and life-threatening complications, which occurred in children treated by a short-course of corticostero?ds for an acute episode such as an asthma crisis, were mostly noticed since 1995. Two deaths occurred. CONCLUSION: These data collected over 16 years as part of a retrospective survey of a paediatric cohort show that varicella, often considered as a mild disease, can be responsible for severe complications in young immunocompetent children. The digestive complications (30%) are the main complication in our study with existence of gingivitis-stomatitis but also lower digestive manifestations (erosive gastritis aspect through endoscopy). These data have all the more to be taken into account because a vaccine, developed for healthy children, is now available in France. A national survey of hospitalised varicella has been set up since March 2003.     

Age-specific questionnaires distinguish GERD symptom frequency and severity in infants and young children: development and initial validation

Two gastroesophageal reflux disease (GERD) symptom questionnaires were developed and tested prospectively in a pilot study conducted in infants (1 through 11 months) and young children (1 through 4 years) with and without a clinical diagnosis of GERD. A pediatric gastroenterologist made the clinical diagnosis of GERD. Parents or guardians at 4 study sites completed the questionnaires, providing information on the frequency and severity of symptoms appropriate to the 2 age cohorts. In infants, symptoms assessed were back arching, choking or gagging, hiccups, irritability, refusal to feed and vomiting or regurgitation. In young children, symptoms assessed were abdominal pain, burping or belching, choking when eating, difficulty swallowing, refusal to eat and vomiting or regurgitation. Respondents were asked to describe additional symptoms. Symptom frequency was the number of occurrences of each symptom in the 7 days before completion of the questionnaire. Symptom severity was rated from 1 (not at all severe) to 7 (most severe). An individual symptom score was calculated as the product of symptom frequency and severity scores. The composite symptom score was the sum of the individual symptom scores. The mean composite symptom and individual symptom scores were higher in infants (P<0.001 and P<0.05, respectively) and young children (P<0.001 and P<0.05, respectively) with GERD than controls. Vomiting/regurgitation was particularly prevalent in infants with GERD (90%). Both groups with GERD were more likely to experience greater severity of symptoms. We found the GERD Symptom Questionnaire useful in distinguishing infants and young children with symptomatic GERD from healthy children.     

Appendicitis in children less than five years old:A challenge for the general practitioner

Acute appendicitis is one of the most common indications for abdominal surgery in pediatrics with peak incidence in the second decade of life. Acute appendicitis in the first years of life is an uncommon event. The clinical presentation is often varied and the diagnosis may be overshadowed by other medical conditions.Gastroenteritis is the most common misdiagnosis, with a history of diarrhea present in 33% to 41% of patients. Pain is the most common presenting symptom in children less than 5 years old, followed by vomiting, fever, anorexia and diarrhea. The most common physical sign is focal tenderness(61% of the patients) followed by guarding(55%), diffuse tenderness(39%), rebound(32%), and mass(6%). Neonatal appendicitis is a very rare disease with high mortality; presenting symptoms are nonspecific with abdominal distension representing the main clinical presentation. The younger the patient, the earlier perforation occurs: 70% of patients less than 3 years develop a perforation within 48 h of onset of symptoms. A timely diagnosis reduces the risk of complications. We highlight the epidemiology, pathophysiology, clinical signs and laboratory clues of appendicitis in young children and suggest an algorithm for early diagnosis.     

Brain abscess in children – epidemiology,predisposing factors and management in the modern medicine era

Aims: Brain abscess is rare in children. Predisposing factors are found in almost 85% of cases. Overall, 25% of brain abscesses develop in children, mostly in the 4–7 years age group. Our study aimed to characterize children with brain abscesses treated in our hospital, identify risk factors, pathogens and short‐term outcome. Methods: A retrospective cohort of 20 years period, (1989–2009) included 27children (0–18 years). Medical records were analysed for age, gender, presenting symptoms and signs, predisposing factors, laboratory tests, imaging, microbiology results, treatment and outcome. Results: Of all the children, 63% (17/27) were male patients; mean age was 7.9 years and 52% were referred from other hospitals. Predisposing factors were identified in 81%, congenital heart disease and otitis were rare and sinusitis was found in 22% of the children. Main symptoms and signs included headaches, fever, neurological signs convulsions, (41%, 81%, 78% and 41% respectively). In 30% of cases, cultures were sterile. All patients were operated in addition to antibiotic treatment. Outcome was good with low mortality rate (3.7%). Conclusions: Manifestations of brain abscess may be subtle. A high index of suspicion and early imaging are warranted, different predisposing factors may reflect early intervention for congenital heart diseases. Mortality is rare in the modern medicine era.     

以神经系统症状起病的儿童血管迷走性晕厥或体位性心动过速综合征88例临床分析

目的 探讨以神经系统症状起病的儿童血管迷走性晕厥（VVS）及体位性心动过速综合征（POTS）的临床特点，为该类疾病早期识别提供依据。方法 回顾性分析88例以一过性意识丧失、头晕、头痛及抽搐等神经系统症状为首发症状，最终确诊为VVS或POTS的患儿的临床资料。结果 88例患儿中，男性35例（40%），女性53例（60%），年龄4~15岁，发病高峰年龄10~13岁。88例患儿皆以一过性意识丧失、头晕、头痛及抽搐为首发症状，经脑电图、脑脊液及头颅磁共振等检查，排除了神经系统疾病，经直立倾斜试验（HUTT）最终确诊为VVS 53例（60%），POTS 35例（40%）。有5例以一过性意识丧失为首发症状的患儿被误诊为癫痫。59例（67%）患儿发病前可追溯到诱因，常见诱因依次为长时间站立、体位变化及剧烈运动。66例（75%）有发作先兆症状，常见的先兆症状依次为胸闷、消化道症状（恶心、呕吐及腹痛）及面色苍白。88例患儿均接受了健康教育、自主神经功能锻炼，53例VVS患儿予口服补液盐治疗，35例POTS患儿予口服补液盐联合美托洛尔治疗。对88例患儿进行为期18个月的随访，随访3、6、12、18个月时的治疗有效率分别为87%、93%、93%、90%。结论 以一过性意识丧失、头晕、头痛及抽搐为首发症状的患儿除了考虑神经系统疾病外，需警惕VVS及POTS等功能性心血管疾病，进一步HUTT检查可明确诊断；明确诊断后早期治疗可取得较好的疗效。     

儿童甲型H1N1流感93例临床特征及治疗分析

目的 分析儿童甲型H1N1流感的临床及实验室特点、治疗效果.方法 2009年5月15日-9月10日北京地坛医院收治、确诊为甲型H1N1流感的患儿93例,男59例,女34例.采集患儿就诊时症状信息,观察并记录患儿住院期间临床症状、体征以及相关的临床特殊检查及实验室检查结果 .治疗方法 采取口服奥司他韦抗病毒、口服中药辨证治疗以及其他对症治疗.对所搜集的临床资料进行分析.结果 (1)甲型H1N1流感患儿发病时以发热(84例,90.3%)、咳嗽(62例,66.7%)、咽痛(21例,38.7%)等为主要症状,体征以体温升高、咽部充血(53例,57.0%)、扁桃体肿大(21例,22.6%)为主.白细胞计数异常者32例,血沉异常者10例,C反应蛋白异常者10例,CD4~+细胞异常者19例,少数患儿出现肝、肾功能异常.(2)采用不同治疗方法 后,患儿发热持续时间[中位数(范围)]:单纯用奥司他韦治疗组1(1～6)d、单纯中医药治疗组1.5(1～6)d,中医药与奥司他韦共同治疗组1(1～5)d,未使用奥司他韦及中医药治疗组2(1～5)d;病毒转阴时间[中位数(范围)]:单纯用奥司他韦治疗组7(3～13)d,单纯中医药治疗组8(4～11)d,中医药与奥司他韦共同治疗组8(5～14)d,未使用奥司他韦及中医药治疗组8(4～13)d.结论 患儿临床表现与成人相似,中医药可能改善儿童甲型H1N1流感的症状,其他方面的临床疗效有待进一步的研究.     

Neurological symptoms in children with intussusception

Aim:  The classical combination of abdominal pain, vomiting, rectal blood loss and a palpable abdominal mass is only present in a minority of children with intussusception. Neurological signs and symptoms have been described, but are not a well understood phenomenon. We performed a retrospective study to ascertain the frequency and nature of these symptoms and to describe the characteristics of the patients presenting in this atypical way.
Methods:  The records of 58 children presenting with intussusception from 2003 to 2008 were reviewed for abdominal and neurological signs and symptoms, duration of symptoms and effectiveness of treatment.
Results:  In 10 out of 58 patients (17%), one or more neurological symptoms were recorded at presentation, with lethargy being the most frequent, followed by hypotonia and fluctuating consciousness. The patients with neurological abnormalities were significantly younger and presented with a shorter duration of symptoms. Therapy was more invasive, although not statistically significant, in this patient category.
Conclusion:  Intussusception should be considered in the differential diagnosis in young children presenting with lethargy, hypotonia and/or sudden alterations of consciousness even in the absence of the classical symptoms of intussusception.     

Symptom profile of common colds in school-aged children

BACKGROUND: Signs and symptoms of a common cold reported in young children are those perceived by caretakers. Objective signs include cough, fever, and sneezing. Subjective symptoms include nasal congestion, feverishness, headache, and sore throat. School-aged children may provide a more accurate picture of the symptom profile during colds because they can self-report. METHODS: Using preprinted diary sheets listing common signs and symptoms, diaries were kept for school-aged children for 10 days after onset of a cold. Nasopharyngeal aspirates were analyzed for respiratory viruses and potential bacterial pathogens. RESULTS: Out of 81 colds studied, the most common signs were cough and sneezing, although the most common symptoms were nasal congestion and runny nose. Other symptoms, including feverishness and headache, were each reported in 15% of children at onset. The majority of children (73%) continued to be symptomatic 10 days after onset. Rhinovirus was detected in 46% and 1 or more potential bacterial pathogens (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis) in 29% of episodes. Symptom profiles for rhinovirus illnesses and those in which potential pathogenic bacteria were detected were not different from the rest. CONCLUSION: The common cold in school-aged children is characterized by nasal congestion, cough, and runny nose. Signs and symptoms usually continue for at least 10 days.     

Sinusitis-induced subdural empyema.

Over a 17 year period, 1975-91, 10 children were managed who had sinusitis-induced subdural or extradural empyema. Their ages ranged from 6 to 14 years, with a mean of 11 years. All presented with worsening headaches, fever, vomiting, all had neurological abnormalities, and all had symptoms or signs suggestive of sinusitis. Initial computed tomography gave normal results in five cases and the empyema was diagnosed on the second or third scan. All patients had symptoms for at least one to two weeks before the diagnosis was made. Streptococcus milleri was the organism most frequently implicated. Medical treatment was started in all cases on admission, but all required surgical intervention before resolution.