Child's brain最新文献

In a 5-year period of prospective study, 369 pediatric patients with multiple trauma (injury to at least two body areas) had injuries scored by a Modification of Injury Severity Scale (MISS). This scale uses the categories and rankings of the Abbreviated Injury Scale-1980 (AIS-80) except that the classification of neurological injuries are scored by the Glasgow Coma Scale (GCS) and other neurological findings (presence of a surgical mass lesion, pupillary light response, and oculocephalic reflexes). The MISS is calculated as the sum of the squares of the three most severely injured body areas. The mean MISS score was 23.8 with 33% of MISS scores greater than 25 and 67% less than 25. Among those with MISS scores greater than 25 there was a 44% mortality and 31% disability. In the group with MISS scores less than 25, there were no mortalities, and a 1% disability (p less than 0.001). Overall mortality was 14% with 9% disability. Mean MISS scores for death and disability were 35.1 and 29.6, respectively. Neurologic injuries were present in 274 patients (74%). 163 patients had severe head injury (coma greater than 6 h duration). 86% of all deaths were due to head injury and all but 2 deaths had some degree of head injury. The remaining 14% of deaths were due to chest and abdominal injuries. Patients with MISS grade 5 injury (critical, survival uncertain) had 74% mortality, while those with grades 4 and 3 injury had 8 and 1.5% mortality. In a comparison with pediatric patients with head injury only (coma greater than 6 h, no multiple trauma) there was found to be a 12% mortality in the head injury only group versus a 33% mortality in the multiple trauma plus head injury group. The MISS serves as an accurate predictor of morbidity and mortality in pediatric trauma. The best predictors of outcome were a MISS less than 25 and the degree of neurological injury.

4 cases of cloverleaf skull syndrome are reported and analyzed after a brief review of the literature is presented. It is noted that reported cases of surgical management of this entity are extraordinarily rare. The rather characteristic displacement of intracranial contents suggests early onset of craniosynostosis (in intrauterine life) and that hydrocephalus is not an invariable complication present at the time of birth. Rather, it appears that the hydrocephalus is secondary to obliteration of the cortical subarachnoid spaces and the presence of a cranial ring. Total craniectomy proved to be a satisfactory treatment, one which was responsible for the reversal of hydrocephalus. Early detection and treatment of this rather rare malformation results in acceptable cosmetic and neurologic improvement.

Brainstem vascular malformation are an uncommon but lethal problem in pediatric neurosurgery. 9 children with confirmed vascular malformations in the brainstem are presented, and the treatment options considered. The recent encouraging results concerning the operative management of these lesions, deserves fullest consideration with the hope that an aggressive management plan can be instituted for the child who otherwise will experience repeated hemorrhage and die from the malformation.

A special entity called subdural effusion with ruptured subarachnoid effusion, which was diagnosed by CT, air study, and RI cisternography, was observed in 14 children of up to 10 months of age. 10 cases that showed symptoms of increased intracranial pressure (ICP) were treated by temporary subdural-peritoneal (S-P) shunt, and the remaining 4 cases that showed no symptoms of increased ICP were treated conservatively. 9 of the 10 cases treated by S-P shunt and 2 of the 4 cases treated conservatively showed good results. Poorly balanced absorption of cerebrospinal fluid (CSF) during the special transitional period of the CSF dynamics may be thought to be a pathogenetic factor.

A rare case of an intracerebral schwannoma in a 10-year-old girl is presented. To our knowledge, only 4 cases of intracranial schwannoma not related to cranial nerves have been previously published, in the absence of von Recklinghausen's disease.

Intracranial pressure (ICP) was monitored in a 12-year-old child before and after closure of a large, skin-covered meningomyelocele. Significant cerebrospinal fluid pulse pressure augmentation was observed over a spectrum of pressures following sac closure. Linear regression analysis was done to define pulse pressure-ICP relationships before and after surgery, and a significant increase in the regression slope was noted postoperatively. It is suggested that the unoperated meningomyelocele defect served as a shock absorber to dampen the intracranial pulse pressure. Meningomyelocele closure removes this shock absorber effect, resulting in pulse pressure augmentation.

We present 2 cases of tumors of the gray basal nuclei with intraventricular hemorrhage and secondary hydrocephalus. Because of the patients' ages, the absence of traumatic antecedents and the angiographic characteristics, the findings were diagnosed as gliomas. In both cases, the existence of hematomas provoked by microangiomatosis was proved after the operation. The differential diagnostic between these two entities is discussed.

Between 1980 and 1982, 8 children with congenital arachnoid cysts were treated at the University of Florida, 2 patients presented with unusual clinical syndromes, including isosexual precocity and a cephalic movement disorder. Cystoperitoneal shunting in combination with ventriculoperitoneal shunting for associated hydrocephalus was employed in the treatment of all supratentorial lesions, and proved to be a safe, efficacious mode of therapy.

A 3-month-old female infant is reported with upper spinal cord injury at birth. Breech presentation and hyperextension of head were observed 1 week prior to delivery. She was delivered by elective cesarean section. The absence of fetal movements 1 day prior to delivery and the uneventful cesarean section strongly suggest a spinal cord injury in utero secondary to hyperextension of the neck.

This paper reviews 75 infants with myelomeningocele treated either at birth or from an early age at Rainbow Babies and Children's Hospital, for whom complete records and psychometric testing (IQ) are available (including complete summaries from referring hospitals). Three groups are compared: (1) infants without complications who were shunted for hydrocephalus (n = 41); (2) infants with complications who were shunted (n = 16), and (3) infants who were not shunted (n = 18). Complications were defined as ventriculitis (positive CSF cultures with elevated protein, depressed glucose and inflammatory cells), anoxia, poorly controlled hydrocephalus or other CNS anomalies such as porencephaly. The mean IQ of infants who were not shunted was 104, of those shunted without complications it was 91, and of those shunted who had complications it was 70. These IQ differences were significant at p less than 0.01, and were not explained by differences in spinal lesion levels.