1/3. Self-inflicted injury in a case of Hallervorden-Spatz disease.Hallervorden-Spatz disease (HSD) is a rare neurodegenerative disorder characterized by abnormally high deposits of iron in the brain. This report describes a child with HSD who presented with self-inflicted ulceration of the lip and tongue, which was initiated during periods of intense oro-facial spasms. Other findings included dental caries and trauma to the primary incisors. comprehensive dental care was carried out under general anaesthesia. The self-mutilation of the oro-facial mucosa was eliminated by placement of upper and lower soft resin bite guards.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/3. Self-inflicted corneal injuries in children with congenital corneal anaesthesia.Severe corneal ulceration related to self-inflicted injury in the presence of congenital corneal anaesthesia is described in four boys under 2 1/2 years of age. The ulcers had failed to heal until it was recognised that the children were scratching their own eyes. The application of arm splints allowed rapid healing. Although corneal ulceration is a recognised complication of congenital corneal anaesthesia, this preventable cause of the ulceration has not previously been recognised. In two cases there were isolated recurrences which healed quickly with the reapplication of splints. All four children had good vision initially, and, although there were no overt gross development abnormalities, two had neurological signs on detailed investigation suggesting cerebellar or brain stem malformation and one had unilateral anophthalmos, talipes equinovarus, and patent ductus arteriosus. All the children showed normal intellectual development. Whether the eye scratching behaviour was the primary cause of the ulceration or merely an aggravating factor, the identification of this abnormal behaviour is important in any child with idiopathic corneal ulceration, as even in the presence of congenital corneal anaesthesia the eyes heal quickly with effective splinting of the elbows. It is therefore important to test sensation of the cornea and face and to consider the possibility of self-inflicted injury in children with refractory corneal ulceration, as in our cases there were no other consistent diagnostic features.- - - - - - - - - - ranking = 7keywords = anaesthesia (Clic here for more details about this article) |
3/3. keratoconjunctivitis artefacta.Six cases of keratoconjunctivitis caused by self-inflicted injury are described. The diagnosis is suggested by the combination of the characteristic sharply delineated lesions localised in the more accessible inferior and nasal quadrants of the bulbar conjunctiva and cornea, together with the unconcerned attitude of the patient and other psychological features. Secondary post-traumatic erosions, infections, and allergies may complicate the clinical appearances, and other functional eye disturbances including corneal anaesthesia may be detected. In all cases the eye condition resolved with a sympathetic but authoritative approach avoiding direct accusation. Avoidance of feelings about bereavement or sexual relationships were directly related to the onset of symptoms in 3 cases. In some patients the psychological mechanism seemed inaccessible and they continued to produce new self-inflicted diseases with considerable physical and psychological morbidity. These more intractable cases need psychiatric investigation but usually resist referral.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |