Child's brain最新文献

Extradural meningeal cysts are rare spinal lesions. The clinical presentation is most often characterized by a slowly progressive spastic paraparesis, frequently associated with pain. Adequate drainage of the cyst with obliteration of the neck of the cyst or complete removal of the cyst can bring about a permanent resolution of the symptoms. The use of somatosensory cortical evoked responses also has an important role in the surgical management of this problem.

13 cases of Goldenhar-Gorlin syndrome are presented in which numerous central nervous system anomalies have been found. These include occipital encephalocele, hydrocephalus, aqueductal stenosis, agenesis of corpus callosum, multiple congenital lipomas and many others. Pertinent literature has been reviewed. It is concluded that any part of the central nervous system can be involved in this condition and that careful evaluation is indicated in order to rule out a treatable intracranial anomaly.

The authors conducted multidimensional echotomography on 119 infants to determine hydrocephalus and other disorders. The process proved quite reliable in showing changes in ventricle size. They raise the idea of conducting broad scale preventive screening among infants in danger groups to achieve early diagnosis.

A personal series of 170 children who underwent 636 operative procedures for hydrocephalus have been followed for 5-12 years. The results of treatment have been analyzed by etiology, years of follow-up, and summarized generally. 5-year survival was 83.5%, current survival is 78.8%. Normal intelligence was found in 63.4% of 5-year survivors, in 64.2% of current survivors. The procedural risk for early shunt infection was 5.8%, while 6.5% of the patients developed a late infection. There is no difference in results based upon measurement of the initial thickness of the cerebral mantle. The mean of the cumulative shunt procedures per patient is 3.72 +/- (SEM) 0.37, and for 5-year survivors it is 3.85 +/- (SEM) 0.39.

This is a retrospective review of all closed-head injured children, ages 1-36 months, admitted to the Children's Memorial Hospital from 1959 to 1978. Injuries ranged from trivial to those producing deep coma. A coma scoring system (to correlate level of consciousness with age and outcome) was devised. Lateralizing neurological signs, fontanelle status, retinal hemorrhages, seizures, and skull fractures were correlated with age, outcome, and late onset of seizures. Children of 1 year and younger were more prone to have a poor outcome in all coma grades except the deepest, where the trend apparently reversed. Of the three components of the coma score (ocular, motor, verbal) the ocular score more constantly reflected neurological damage. Subdural hematomas, which were largely responsible for poorer outcomes in infants, occurred almost exclusively in children under 1 year of age. Lateralizing neurological signs, which were not found to correlate directly with a poor outcome, were unilateral Babinski, ataxia, and the combination of ocular deviation and hemiparesis (which is probably a seizure variant). Hemiparesis alone, however, did correlate directly with a poor outcome, as did full, and especially tense, fontanelle, and split sutures or diastatic fractures. Linear fractures, when unilateral, were not associated with a poor outcome, although bilateral linear and depressed fractures were. Bilateral retinal hemorrhages were found to be both quantitatively and qualitatively different from unilateral retinal hemorrhages, and to be statistically more often associated with subdural hematoma.

Among the cerebral malformations accompanying cystic cavity in the dorsal midline, common radiological findings of galenic dysgenesis are found in 10 cases, which are now reported as dorsal cyst malformations. The authors classified dorsal cyst malformations into prosencephalic, interhemispheric, and porencephalic types according to clinical, radiological, and presumed pathogenetic characteristics. In contrast to recent trends that most of cerebral malformations with dorsal midline dysgenesis are included in the holoprosencephalic category, the authors emphasize that these interhemispheric and porencephalic types of dorsal cyst malformations, though presenting interhemispheric cyst with callosal defect or broad communication between the lateral ventricles, should be separated from holoprosencephaly, because they are completely hemispheric.

4 patients with brain stem tumors were treated with high-dose ACNU with autologous bone marrow rescue. Hematologic and nonhematologic toxicities were not profound. There was objective evidence of response in 2 out of the 4. All were alive for 11-21 months from onset. Safe administration of high-dose ACNU with marrow rescue will warrant further control studies to determine its superiority over conventional doses.

Three cases with the Meckel syndrome were autopsied and found to have: arhinencephaly , polymicrogyria , aqueductal stenosis, heterotopia of glial tissue, hypoplasia or agenesis of the cerebellar vermis, cranium bifidum associated with large occipital ventriculocele and others. The anomalies at the level of posterior fossa in this condition are classified as those belonging to the Chiari type III group of anomalies. This unusual set of anomalies which forms pathogenetic link between the Dandy-Walker and Chiari-Arnold group of anomalies in the posterior fossa seems to be very frequent in the Meckel syndrome. The therapeutic emphasis is on genetic counseling in view of the recessive inheritance of the syndrome.

Cerebellar hemorrhage is rare in childhood, and is usually the result of trauma or a ruptured arteriovenous malformation. We report acute subarachnoid hemorrhage as the presenting manifestation of medulloblastoma and review the atypical presentation and causes of cerebellar hemorrhage in infants and children.