Journal of Pediatric Neurology - Volume 2, issue 3
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Journal of Pediatric Neurology is an English multidisciplinary peer-reviewed medical journal publishing articles in the fields of child neurology, pediatric neurosurgery, pediatric neuroradiology, child psychiatry and pediatric neuroscience.
Journal of Pediatric Neurology encourages submissions from authors throughout the world. The following articles will be considered for publication: editorials, original and review articles, rapid communications, case reports, letters to the editor and book reviews. The aim of the journal is to share and disseminate knowledge between all disciplines that work in the field of pediatric neurology.
Abstract: Brain abscess is an uncommon but serious life threatening infection in children. The infection can originate from contiguous sites of existing infections, such as chronic otitis media, dental infection, mastoiditis, or sinusitis. The infection can also occur in children with cyanotic congenital heart disease where the predominant organisms are viridans, microaerophilic, or anaerobic streptococci or following head trauma where Staphylococcus aureus, viridans Streptococci and Streptococcus pneumoniae are the most prevalent isolates. Brain…scans, computerized tomography and magnetic resonance imaging are important tools that enable accurate diagnosis of the infection. Proper selection of antimicrobial with good intracranial penetration is critical in the management of intracranial infection. Brain abscess, especially in the early phase of cerebritis, may respond to antimicrobial therapy without the need for surgical drainage. Delay in surgical drainage can be associated with high mortality or morbidity. (J Pediatr Neurol 2004; 2(3): 125–130).
Abstract: This is the first report of epidemic stroke and epidemic reversible ischemic neurological deficit. Objectives of this study were to confirm that strokes can occur in epidemics, to identify the association of any pathogen, to study its clinical characteristics, to study its pathology by neuroimaging, to know the arterial territory involved, to understand the effect of symptomatic treatment and to know if some ischemic cases are reversible. This is a cross sectional and case-control study. It…included 55 stroke cases. It was performed in hospitals of Andhra Pradesh from 1st June 2003 to 12th August 2003. The cases were analyzed for age, sex, symptoms and signs, investigations done, treatment given and course of the disease. There was a 13-fold increase in the incidence of pediatric strokes. Diagnostic symptoms and signs included abdominal colic in 28 (50.91%), diarrhea without dehydration or dyselectrolytemia in 26 (47.27%), focal symptoms and signs in 33 (60%) and meningeal irritation signs in 0%. Cerebrospinal fluid, except for increased pressure, was normal in 100%. Computerized tomography revealed hypodensities restricted to middle cerebral artery territory. Twenty-eight (50.91%) cases had evidence of Chandipurainfection. Strokes do occur in epidemics. Though infection is the cause, etiologic role of Chandipura virus is doubtful. Enterovirus 71, Varicella and any other yet unidentified endotheliotropic virus should be investigated for. Epidemic stroke has characteristic features. Middle cerebral artery territory is involved. Early treatment of raised intracranial pressure significantly reduced Case Fatality Rate. Twenty-three (85.19%) of 27 survived cases recovered totally within 3 months. Two (7.41%) cases developed late onset refractory epilepsy and four (14.81%) continued to have hemiplegia after 8 months. (J Pediatr Neurol 2004; 2(3): 131–143).
Abstract: The incidence of sudden death in Rett syndrome is greater than that of the general population. Previous studies suggested cardiac dysautonomia and long QT interval as a prime suspect cause but there are no echocardiographic studies in Rett girls. The aim of this study was the analysis of the cardiac dysautonomia and echocardiographic abnormalities in females affected with Rett syndrome as a possible explanation of the higher risk for sudden death, observed in these subjects. Standard…transthoracic echocardiography, heart rate variability and corrected QT interval were studied in 32 Rett girls (4 ± 4.1 years) and in 30 age-matched healthy females (6.8 ± 2.1 years). All Rett girls had cardiac dysautonomia, with loss of physiological heart rate variability but normal cardiac structures, dimensions and function. These results suggest that sudden death in Rett girls may be linked to an electrical instability and not to cardiac structures or valve alterations. (J Pediatr Neurol 2004; 2(3): 145–148).
Keywords: Rett syndrome, echocardiography, cardiac dysautonomia
Abstract: At our institution a policy of early nasal continuous positive airway pressure (ENCPAP) in extremely low birth weight (ELBW) infants has been followed during the past 5 years. Routine intubation and surfactant administration is no longer our practice. The impact of this policy on infant outcomes is under investigation. This is a retrospective review of ELBW infants (< 1000 g) born at our institution between January 1998 and July 2002. Data on hearing deficits, visual impairment…and Bayley scores at 3–6 months of corrected age were analyzed. Ninety-two ELBW infants were identified. Sixteen (17.4%) infants died and 14 (15.2%) ELBW were transferred to another institution. For the 62 survivors discharged home, mean gestational age was 26.4 ± 1.6 wks and birth weight was 797±129 g. The majority (67%) of these ELBW infants were managed with ENCPAP. Three (10.3%) infants had abnormalities on hearing evaluation. Three (4.8%) infants had retinopathy of prematurity requiring laser. Thirty infants were followed up developmentally. Four of these infants had normal neurodevelopmental evaluation at 6–8 weeks corrected age, and did not return for further follow-up. Twenty-six infants were followed at least through the three to six month visit. Six (23%) remained on high calorie formula with four (14%) infants requiring nasogastric tube feeding. Seven (25%) infants had Bayley mental developmental index < 70 (< 2 SD) and seven (25%) infants had Psychomotor Developmental Index < 70. Neurodevelopmental morbidity remains a concern for ELBW infants managed with ENCPAP. Although these results are subject to selection bias, the rates of neurodevelopmental morbidity are similar to those reported in the recent literature. (J Pediatr Neurol 2004; 2(3): 149–152).
Abstract: The prognosis of pediatric low-grade gliomas is relatively favorable, but unresectable progressive tumors remain a challenge. Chemotherapy including carboplatin-containing regimens can delay the need for radiation therapy in young children. However, hypersensitivity reactions to carboplatin can at times be a severe complication. We have retrospectively evaluated and characterized the hypersensitivity reactions associated with carboplatin administration in pediatric low-grade glioma patients treated on an outpatient basis according to the SIOP/GPOH (International Society of…Pediatric Oncology/Gesellschaft für Pädiatrische Onkologie und Hämatologie) low-grade glioma 1996 protocol, and also reviewed the literature. Of nine patients consecutively treated with carboplatin, seven (78%) developed carboplatin hypersensitivity reactions. The first hypersensitivity reactions (always grade 2) occurred after a median of nine courses (range, 7–12). Although desensitization has been used successfully, there have been reports of severe cases of allergic reaction to carboplatin despite desensitization, including anaphylaxis and death. Since carboplatin hypersensitivity reactions are common and desensitization has not been proven to be safe, efforts should be made to design future therapy protocols for low-grade gliomas with clear guidelines on how to substitute carboplatin when hypersensitivity reactions occur. (J Pediatr Neurol 2004; 2(3): 153–157).
Abstract: A child with Landau-Kleffner syndrome who changed to continuous spike wave discharges both during sleep as well as awake is reported in this communication. A 4.5-year-old boy developed rapidly progressive mixed aphasia with relative preservation of writing and drawing skills. Electroencephalogram showed 2–2.5 Hz spike wave discharges more marked during slow wave sleep. Single photon emission tomography revealed hypoperfusion of the left frontotemporoparietal area. The patient did not respond to methylprednisolone, intravenous…immunoglobulin and a number of antiepileptic drugs. At 2 year follow up there was no clinical improvement and the EEG showed continuous spike wave discharges not only during sleep but also during waking. He was aphasic but had preservation of spatial intelligence. This case report highlights the severe and resistant form of Landau-Kleffner syndrome and the heterogeniety of the condition. (J Pediatr Neurol 2004; 2(3): 159–162).
Keywords: Landau-Kleffner syndrome, aphasia, SPECT, EEG, electrical status epilepticus
Abstract: Intracranial dermoid cyst is a rare entity, accounting less than 1% of all intracranial tumors. The most common localization is midline at the posterior fossa. They usually cause symptoms related to compression, infection, hydrocephalus, or a combination of all. The controversy arises about the preoperative treatment planning. Since infection is a major risk in those patients, inserting a shunt at the same session of tumor removal may not be achieved. Total resection of tumor is a…must. We present two cases of posterior fossa dermoid cysts with hydrocephalus as a complication. First case presented with the symptoms of meningitis. She had no hydrocephalus at the time of surgery. The second case had hydrocephalus but no sign of infection. Both cases needed ventriculo-peritoneal shunt insertion. Hydrocephalus may occur at any time during the course of the disease. But appropriate time of handling is important to avoid increased morbidity and mortality related to the shunt infection failure. (J Pediatr Neurol 2004; 2(3): 163–166).
Abstract: A case of temporary acquired central hypoventilation following craniopharyngioma surgery is presented. This is a complication which has not been previously described in suprasellar surgery. Potentially mechanisms of the respiratory disorder are discussed. The most likely etiology is felt to be respiratory drive depression stemming from hypothalamic injury. (J Pediatr Neurol 2004; 2(3): 167–170).