Child's brain最新文献

Bayley developmental assessments were performed at 12 months corrected age on 11 preterm infants, all of whom had undergone 133-Xenon cerebral blood flow measurements (CBF) on the 1st day of life and neonatal computerized tomography scans for the detection of intraventricular hemorrhage. The Bayley mental index was found to vary as a quadratic function of CBF to the left hemisphere, with moderate CBF values associated with more favorable outcomes than either low or high CBF values.

A useful technique for skin repair in medium-sized lumbar or lumbosacral myelomeningoceles is described. It consists in the displacement towards the midline of two lateral triangular flaps located on each side of the lesion. This technique has been used to cover skin defects in other regions of the body, but not in the lumbar region for myelomeningoceles. The results are encouraging.

Clinical and radiological findings in a 2-year-old boy with a large multilocular infratentorial arachnoid cyst are presented. The cyst was extended in the bilateral paracollicular and retrocerebellar region and was communicating with each other but not with the ventricular system. Associated with those cysts was a significant degree of hydrocephalus due to compression of the fourth ventricle. Delayed metrizamide CT scan showed totally isolated cysts from CSF circulation although the cystic content was determined as the CSF.

Congenital orbital teratoma is a rare tumor that usually presents with unilateral proptosis in a normal full term infant. These tumors are usually confined to the orbit without extension into the intracranial cavity. A few cases with intracranial extension have been reported. We have developed a combined ophthalmological, otolaryngological and neurosurgical approach to deal with this rare tumor when it extends intracranially.

Child abuse is a complex sociophysical phenomenon in which a child may suffer physical and mental assault ranging from death to emotional deprivation. In this report, an effort is made to identify the pathogenetic mechanisms of head injury in child abuse and to describe the site of injury, incidence of head injury, and difficulties encountered in establishing a doctor-family relationship. During the years 1970 through 1979, 621 children were confirmed victims of child abuse and treated by the medical staff at the Children's Memorial Hospital in Chicago. Of these, there were 77 children (12%) who suffered associated head injuries ranging from cerebral concussion to irreversible brain damage and/or death. 85% of these head-injured children were under the age of 2 years. 62% were male and 38% female. In analyzing the type of injury which resulted in an associated head injury, we learned that 54% of all injuries were caused by direct blows to the head, face and other parts of the body, 35% were due to dropping, throwing or falling; only 8% were caused by 'shaking'. 55 injuries (48%) out of 115 trauma cases were thought to be caused by injury to head or face. 53 patients showed 113 external skin wounds such as ecchymoses of eyes, excoriations, bruises, contusion, hematoma, burns, etc. 46% of all external wounds were found over the head and face. This may probably indicate to us that a traumatic force causing injury to the brain is directed to the head and face. The traumatic mechanisms are analyzed and discussed to assess the behavioral derangement of the assault.

During the last 15 years, 34 children were treated for a brain abscess. 13 (38%) had cyanotic heart disease; 12 (35%) had an ENT infection. The standardized treatment protocol included puncture of the abscess and administration of antibiotic and antiedematous drugs. Postoperative permanent epidural monitoring of intracranial pressure and, in the last 5 years, repeated CT scans indicated if retapping the abscess or reinforcing the antiedematous treatment was necessary. In 7 out of these 34 cases the abscess had to be excised. Postoperative mortality rate was 6%. Overall mortality rate was 12%. Neurological sequelae were slight. Epilepsy frequency was 10%. Mental retardation (18%) was found only in cyanotic congenital heart disease to which it is related. Repeated CT scans demonstrated the progressive disappearance of the capsule within a few months. This study shows an improvement in the results when brain abscesses in children are punctured rather than excised.

Gliomas of the optic pathway are considered to be slowly growing, potentially benign neoplasms. Association of this tumor with neurofibromatosis has been well established. We have recently evaluated 7 children with putative evidence of optic glioma, 6 of whom had additional evidence of neurofibromatosis. All children had CT scans and visual-evoked responses. CT scan allows anatomic assessment of the optic nerve mass while evoked responses offer the possibility of identifying functional abnormalities in the optic pathway. It is felt that both these modalities will add in the early diagnosis of optic gliomas and help to further establish the true natural history of this tumor.

We report the results of a randomized, double-blind, placebo-controlled study to determine whether phenytoin administered soon after a head injury lessens the incidence of late post-traumatic epilepsy in children. 41 patients were randomized into either a phenytoin or placebo group and followed for 18 months. The patients were administered phenytoin or placebo intravenously or intramuscularly within 24 h of hospital admission. The patients were parenterally administered phenytoin or placebo until oral doses could be tolerated. There was no significant difference in the percentage of children having seizures in the treated and placebo groups (p = 0.25).

61 infants and children underwent surgery of acute hygroma, acute subdural hematoma, chronic subdural hygroma, chronic subdural hematoma, and subdural empyema. Long time-follow up including computerized tomography could be performed in 20 of these cases. Only 3 CT-scans had been without pathological finding. The most common finding had been an enlargement of the inner and outer CSF spaces suggesting cerebral atrophy. No correlation had been found to kind of surgical treatment and clinical status.