Brain Magnetic Resonance Imaging Abnormalities Research Articles

Short\u2010term outcomes in infants with mild neonatal encephalopathy: a retrospective, observational study

BackgroundNeonatal encephalopathy due to acute perinatal asphyxia is a major cause of perinatal brain damage. Moderate to severe neonatal encephalopathy is associated with high mortality and morbidity rates. However, the neurodevelopmental outcomes in neonates with mild neonatal encephalopathy are unclear. The primary aim of this single-center observational study was to assess the short-term outcomes in term neonates with mild neonatal encephalopathy due to perinatal asphyxia. A secondary aim was to identify predictors of poor prognosis by identifying the characteristics of these infants according to their short-term outcomes.MethodsWe retrospectively investigated all infants with perinatal asphyxia at Tokyo Metropolitan Children’s Medical Center from January 2014 to December 2019. An abnormal short-term outcome was defined as any one of the following: seizures or abnormal electroencephalography, abnormal brain magnetic resonance imaging obtained within the first 4 weeks of life, and abnormal neurological examination findings at discharge.ResultsIn total, 110 term infants with perinatal asphyxia during the study period were screened and 61 were diagnosed with mild neonatal encephalopathy. Eleven (18 %) of these infants had an abnormal short-term outcome. The median Thompson score at admission was significantly higher in infants with abnormal short-term outcomes than in those with normal short-term outcomes (5 [interquartile range, 4-5.5] vs. 2 [interquartile range, 1–3], p < 0.01). Receiver operating characteristic curve analysis showed that a cutoff value of 4 had high sensitivity and specificity (90.9 and 83.0 %, respectively) for prediction of an abnormal short-term outcome.Conclusions18 % of infants with mild encephalopathy had an abnormal short-term outcome, such as abnormal brain magnetic resonance imaging findings. The Thompson score at admission may be a useful predictor of an abnormal short-term outcome in infants with mild neonatal encephalopathy.

Clinical Characteristics and Prognostic Factors of Children With Anti-N-Methyl-D-Aspartate Receptor Encephalitis.

Objective: Anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis is the most common autoimmune encephalitis in pediatric patients. The study aimed to investigate the clinical characteristics and prognostic factors of anti-NMDA receptor encephalitis in children in South China.Methods: This was a retrospective study of children diagnosed with anti-NMDA receptor encephalitis between 01/2014 and 12/2017 at Hunan Children's Hospital. Laboratory, brain magnetic resonance imaging (MRI), and electroencephalography data were collected. The short-term (6-month) outcomes were assessed using the Liverpool score by the same pediatric neurologist. The children were divided into good (scores 4–5) and poor (score <3) clinical outcomes.Results: Among the 51 patients, 21 (41.2%) were male. The most common clinical symptoms were dyskinesia (88.2%), personality change (84.3%), seizure (82.4%), and cognitive disorder (31.4%). Two were transferred to another hospital, 45 (91.8%) received intravenous immunoglobulins, 41 (83.7%) received methylprednisolone, and 8 (16.3%) received plasma exchange. Eight (16.3%) received rituximab for second-line treatment, six after intravenous immunoglobulin and methylprednisolone treatment, and two after plasma exchange therapy failed. Seven were lost to follow-up. The short-term outcome was good in 23 patients. Cognitive disorder [odds ratio (OR): 23.97, 95% confidence interval (CI): 1.12–513.30, P = 0.042) and abnormal brain MRI (OR: 14.29, 95% CI: 1.36–150.10, P = 0.027] were independently associated with a poor short-term outcome after adjustment for age, GCS, and rituximab use.Conclusions: MRI abnormalities and cognitive disorders are independently associated with poor short-term outcomes in children with anti-NMDA receptor encephalitis. The use of rituximab is not associated with the 6-month outcomes.

Elevated sTREM2 and NFL levels in patients with sepsis associated encephalopathy

Purpose Sepsis-associated encephalopathy (SAE) is a common manifestation of sepsis that may lead to cognitive decline. Our aim was to investigate whether the neurofilament light chain (NFL) and soluble triggering receptor expressed on myeloid cells 2 (sTREM2) could be utilized as prognostic biomarkers in SAE. Materials and methods In this prospective observational study, baseline serum levels of sTREM2 and cerebrospinal fluid (CSF) levels of sTREM2 and NFL were measured by ELISA in 11 SAE patients and controls. Patients underwent daily neurological examination. Brain magnetic resonance imaging (MRI) and standard electroencephalography (EEG) were performed. Cognitive dysfunction was longitudinally assessed after discharge in 4 SAE patients using the Mini-Mental State Examination (MMSE) and Addenbrooke’s Cognitive Examination-Revised (ACE-R) tests. Results SAE patients showed higher CSF sTREM2 and NFL levels than controls. sTREM2 and NFL levels were not correlated with the severity measures of sepsis. Three months after discharge, 2 SAE patients displayed ACE-R scores congruent with mild cognitive impairment (MCI), persisting in one patient 12 months after discharge. SAE patients with MCI showed higher CSF NFL levels, bacteremia, and abnormal brain MRI. Patients with increased serum/CSF sTREM2 levels showed trends towards displaying poorer attention/orientation and visuo-spatial skills. Conclusions sTREM2 and NFL levels may serve as a prognostic biomarker for cognitive decline in SAE. These results lend further support for the involvement of glial activation and neuroaxonal degeneration in the physiopathology of SAE.

Short-term developmental outcomes in neonates born to mothers with COVID-19 from Wuhan, China.

BackgroundCoronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging disease. The consequences of SARS-CoV-2 exposure in infants remain unknown. Therefore, this study aims to investigate whether neonates born to mothers with COVID-19 have adverse brain development.MethodsThis multicenter observational study was conducted at two designated maternal and children’s hospitals in Hubei Province, mainland China from February 1, 2020 to May 15, 2020. Neonates born to mothers with COVID-19 were enrolled. Brain magnetic resonance imaging (MRI) findings, and volumes of grey and white matters, and physical growth parameters were observed at 44 weeks corrected gestational age.ResultsOf 72 neonates born to mothers with COVID-19, 8 (11%) were diagnosed with COVID-19, 8 (11%) were critically ill, and no deaths were reported. Among the eight neonates that underwent brain MRI at corrected gestational age of 44 weeks, five neonates were diagnosed with COVID-19. Among these five neonates, three presented abnormal MRI findings including abnormal signal in white matter and delayed myelination in newborn 2, delayed myelination and brain dysplasia in newborn 3, and abnormal signal in the bilateral periventricular in newborn 5. The other three neonates without COVID-19 presented no significantly changes of brain MRI findings and the volumes of grey matter and white matter compared to those of healthy newborns at the equivalent age (P > 0.05). Physical growth parameters for weight, length, and head circumference at gestational age of 44 weeks were all above the 3rd percentile for all neonates.ConclusionsSome of the neonates born to mothers with COVID-19 had abnormal brain MRI findings but these neonates did not appear to have poor physical growth. These findings may provide the information on the follow-up schedule on the neonates exposed to SARS-CoV-2, but further study is required to evaluate the association between the abnormal MRI findings and the exposure to SARS-CoV-2.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12519-021-00426-z.

The visibility of the periventricular crossroads of pathways in preterm infants as a predictor of neurological outcome and occurrence of neonatal epileptic seizures

AimTo evaluate the relationship between the neurological outcome, neonatal epileptic seizures, and signal-intensity visibility of the frontal and parietal periventricular crossroads of pathways on brain magnetic resonance imaging (MRI) in preterm infants at term-equivalent age.MethodsThe study enrolled 48 preterm infants born between 2012 and 2016. The signal-intensity characteristics of the frontal and parietal periventricular crossroads were evaluated and classified into four grades. A non-favorable outcome was defined as a motor and functional disorder with developmental delay and/or cerebral palsy.ResultsNeonatal seizures, epilepsy, pathological EEG and brain ultrasound finding, and brain MRI abnormalities were mostly found in neonates with non-favorable outcomes. Visible frontal and parietal periventricular crossroads were associated with a normal neurologic outcome (P = 0.0004; P = 0.0009, respectively). Not-visible or slightly visible periventricular crossroads were associated with non-favorable outcomes in the case of frontal crossroads (P = 0.036) and not-visible periventricular crossroads in the case of both frontal and parietal crossroads (P = 0.001, P = 0.015, respectively). The visibility of the frontal and parietal periventricular crossroads was associated with a lack of neonatal epileptic seizures (P = 0.03; P = 0.02, respectively). The frontal crossroads were more frequently slightly visible, while the parietal periventricular crossroads were more frequently visible.ConclusionPoor visibility of the frontal and parietal crossroads of pathways on MRI is associated with neonatal epileptic seizures and poor neurological outcomes in preterm infants at term-equivalent age.

Clinical seizures and unfavorable brain MRI patterns in neonates with hypoxic ischemic encephalopathy.

The aim was to examine whether clinical seizures and amplitude-integrated electroencephalogram (aEEG) patterns in infants with hypoxic ischemic encephalopathy (HIE) can predict the extent of brain injury on magnetic resonance images (MRI) and the long-term neurodevelopmental outcomes at 18∼24 months of age.HIE infants who underwent therapeutic hypothermia (TH) between June 2014 and March 2017 were included in this study. Infants with clinical seizure were analyzed for aEEG patterns and the extent of brain injury on MRI findings. Clinical seizure, aEEG, and brain MRI were assessed and compared with neurodevelopmental outcomes at 18∼24 months of age.Among the 97 HIE infants enrolled in this study with brain MRI scans, 78 (73.1%) TH-treated HIE infants exhibited clinical seizures. More abnormalities on a EEGs and more significant use of first and second antiepileptic drugs (AEDs) were significantly higher in the clinical-seizure group with longer hospitalized days. At a corrected 18 to 24 months of age, HIE infants in the clinical-seizure group with more extension of injury lesions on diffusion-weighted MRI scans exhibited significantly more delayed neurodevelopment. A risk factor analysis indicated that male infants who stayed in the hospital for more than 11 days were at a higher risk of having clinical seizures. The lesion size in MRI greater than 37 pixels was a risk factor with an 81.8% accuracy.Seizures in HIE infants may predict abnormal brain MRI scans and abnormal neurodevelopment at 18 to 24 months of age.

Cranial MRI Abnormalities and Long-term Follow-up of the Lesions in 770 Girls With Central Precocious Puberty

Central precocious puberty (CPP) may arise from central nervous system (CNS) lesions in a few affected girls. Recently, the incidence of girls with CPP has increased mostly in 6-8 year olds, in whom the necessity of magnetic resonance imaging (MRI) is debated. To investigate the frequency, long-term outcome and potential predictors of CNS lesions in a large cohort of girls with CPP. A multicenter cohort of 770 Turkish girls with CPP who had systematic cranial MRI between 2005 and 2017. Age at puberty onset was <6 years in 116 and 6-8 years in 654. CNS lesions were followed until final decision(6.2 ± 3.1 years). Potential predictors of CNS lesions were evaluated by univariate analyses. A total of 104/770 (13.5%) girls had abnormal brain MRI. Of these, 2.8% were previously known CNS lesions, 3.8% had newly detected and causally related CNS lesions, 3.1 % were possibly, related and 3.8% were incidental. Only 2 (0.25%) neoplastic lesions (1 low grade glioma and 1 meningioma) were identified; neither required intervention over follow-up of 6 and 3.5 years respectively. Age at breast development <6 years (odds ratio [OR] 2.38; 95% CI 1.08-5.21) and the peak luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratio >0.6 (OR 3.13; 95% CI 1.02-9.68) were significantly associated with CNS lesions. However, both patients with neoplastic lesions were >6 years old. Although age and LH/FSH ratio are significant predictors of CNS lesions, their predictive power is weak. Thus, systematic MRI seems to be the most efficient current approach to avoid missing an occult CNS lesion in girls with CPP, despite the low likelihood of finding a lesion requiring intervention.

Clinico-Radiological Correlation in 26 Egyptian Children with Glutaric Acidemia Type 1.

Glutaric acidemia type 1 (GA1) is an inherited neurometabolic disease with significant morbidity. However, neuro-radiological correlation is not completely understood. The study aimed to characterize the neuroimaging findings and their association with neurological phenotype in GA1 children. Twenty-six Egyptian children (median age = 12 months) diagnosed with GA1 underwent clinical evaluation and brain magnetic resonance imaging (MRI). We objectively assessed the severity of neurological phenotype at the time of MRI using movement disorder (MD) and morbidity scores. Evaluation of brain MRI abnormalities followed a systematic and region-specific scoring approach. Brain MRI findings and scores were correlated with MD and morbidity scores, disease onset, and presence of seizures. Fifteen (57.7%) cases had insidious onset, eight (30.8%) manifested acute onset, whereas three (11.5%) were asymptomatic. Ten (38.5%) cases had seizures, five of which had no acute encephalopathic crisis. Putamen and caudate abnormalities (found in all acute onset, 93.3 and 73.3% of insidious onset, and one of three asymptomatic cases) were significantly related to MD (p = 0.007 and 0.013) and morbidity (p = 0.005 and 0.003) scores. Globus pallidus abnormalities (50% of acute onset, 46.7% of insidious onset, and one of three of asymptomatic cases) were significantly associated with morbidity score (p = 0.023). Other MRI brain abnormalities as well as gray and white matter score showed no significant association with neurological phenotype. Younger age at onset, acute onset, and seizures were significantly associated with worse neurological manifestations. Patients with GA1 manifest characteristic and region-specific brain MRI abnormalities, but only striatal affection appears to correlate with neurological phenotype.

Magnetic resonance imaging (MRI) volumetry in children with nonlesional epilepsy, does it help?

BackgroundEpilepsy is a chronic condition characterized by repeated spontaneous seizures. It affects up to 1% of the population worldwide. Children with magnetic resonance imaging (MRI) negative (or “nonlesional”) focal epilepsy constitute the most challenging pharmacoresistant group undergoing pre-neurosurgical evaluation. Volumetric magnetic resonance imaging (VMRI) is a non-invasive brain imaging technique done to measure the volume and structure of specific regions of the brain. It is useful for many things, but primarily for discovering atrophy (wasting away of body tissue) and measuring its progression. The aim of this study is to assess role of volumetric magnetic resonance imaging in evaluation of nonlesional childhood epilepsy in which no specific findings detected in conventional MRI.ResultsThere were 20 children with normal MRI brain volumetry (33.3%) and 40 children (66.6%) with abnormal MRI brain volumetry.Grey matter volume in the abnormal group was significantly higher (P value was 0.001*) than the normal group (mean ± S.D 934.04 ± 118.12 versus 788.57 ± 57.71 respectively). White matter volume in the abnormal group was significantly smaller (P value was < 0.0001*) than in the normal group (mean ± S.D 217.79 ± 65.22 versus 418.07 ± 103.76 respectively). Right hippocampus CA4-DG volume in the abnormal volume group was found to be significantly smaller (P value < 0.0001*) than that of the normal group volume (mean ± S.D 0.095 ± 0.04 versus 0.32 ± 0.36 respectively). Right hippocampus subiculum volume in the abnormal volume group were found to be significantly smaller (P value was < 0.0001*) than that of the normal group volume (mean ± S.D 0.42 ± 0.11 versus 0.84 ± 0.09 respectively). Thalamus volume in the abnormal group was significantly smaller (P value 0.048*) than in the normal group (mean ± S.D 10.235 ± 3.22 versus 11.82 ± 0.75 respectively). Right thalamus was significantly smaller (P value was 0.028*) than in the normal group (mean ± S.D 5.01 ± 1.62 versus 5.91 ± 0.39 respectively). The sensitivity of the right hippocampus subiculum volume and right hippocampus CA4-DG was 100%. The sensitivity of white matter volume and grey matter volume and thalamus was 85% and 75% and 55% respectively. The specificity of the right hippocampus subiculum volume and right hippocampus CA4-DG was 90% and 90% respectively. The specificity of the right hippocampus subiculum volume and right hippocampus CA4-DG and grey matter volume and white matter volume and total hippocampus and thalamus was 100%. The specificity of brain volume was 60%. The accuracy of the right hippocampus subiculum volume and right hippocampus CA4-DG was 100%. The specificity of white matter volume, grey matter volume, thalamus, total hippocampus, and brain volume was 97%, 87%, 65%, 61%, and 57% respectively.ConclusionVolumetric magnetic resonance imaging is a promising imaging technique that can provide assistance in evaluation of nonlesional pharmacoresistant childhood epilepsy.

HPeV3-associated acute encephalitis/encephalopathy among Japanese infants

ObjectiveThe current study aimed to identify and compare the clinical characteristics of human parechovirus type 3 (HPeV3)-associated acute encephalitis/encephalopathy (HPeV3E/E) between infants with abnormal brain magnetic resonance imaging (MRI) findings (typical, or MRI-positive HPeV3E/E) and those with MRI-negative findings (MRI-negative HPeV3E/E). MethodsThis is a retrospective study on patients with HPeV3 infection, and a two-step questionnaire survey performed on 837 hospitals in Japan between 2014 and 2016. ResultsWe identified 240 infants with HPeV3 infection, of which 34 had been clinically-diagnosed HPeV3E/E (cHPeV3E/E). However, detailed clinical data were provided by 32 of the 34 patients. Among these 32, 23 had undergone MRI and were categorized into two groups, MRI-positive (n = 17) and -negative (n = 6). There were no significant intergroup differences in clinical lab results or symptoms, except for gastrointestinal symptoms that were only present in the MRI-negative patients. The MRI-positive group showed white matter involvement on brain MRI during the acute phase, and 8 patients presented with lesions on follow-up MRI. Furthermore, 4 (50%) of the 8 patients had neurological sequelae. ConclusionClinical characteristics of cHPeV3E/E patients with and without lesions on brain MRI showed no significant differences. Therefore, considering the difficulty in distinguishing febrile infants with cHPeV3E/E from those with a sepsis-like illness, during an HPeV3 infection epidemic, it is imperative to frequently perform brain MRI in febrile infants presenting with severe disease for the early diagnosis of HPeV3E/E presenting with brain lesions.

Aetiologies and clinical patterns of hypopituitarism in Sudanese children

There is paucity of reported information regarding aetiology and clinical profile of hypopituitarism from resource-limited countries particularly in populations with high rates of consanguineous marriages. Here, we are reporting the first data on this aspect from Sudan. This is a descriptive, retrospective, hospital-based study, carried out in the two main paediatric endocrinology centres in Sudan (Gafaar Ibn Auf Paediatric Tertiary Hospital and Soba University Hospital, Khartoum) from January 2006 up to December 2014. Patients' records were reviewed for relevant demographical, clinical, hormonal and radiological data using pretested study forms. The study included 156 patients. One hundred and one patients were males (M: F = 1.8:1). The commonest age groups were adolescents (57.7%). Consanguinity was found in 77.8% of patients overall and 91% of patients with congenital aetiologies. The commonest clinical presentation was short stature (93.5%). Congenital causes (86.5%) were more prevalent than acquired causes (13.5%). There were six family clusters with multiple pituitary hormone deficiencies (MPHD) and three families with isolated growth hormone (GH) deficiency (IGHD). Most of the congenital cases with MPHD were phenotypic for PROP1 gene mutation (77.5% of sporadic cases and 50% of familial cases). Craniopharyngioma was the commonest of the acquired causes (10.2%). GH was the most frequent hormone deficient (89.7%). Abnormal Magnetic resonance imaging brain findings were significantly seen more in MPHD in comparison to IGHD. The genetic forms of hypopituitarism in populations with high rates of consanguineous marriage like Sudan may be higher than those reported internationally. Molecular genetic studies are, therefore, highly recommended.

Predictors exploration of abnormal brain magnetic resonance versus normal brain computed tomography imaging in acute carbon monoxide poisoning

Acute brain lesions observed on magnetic resonance imaging (MRI) performed during acute-phase carbon monoxide (CO) poisoning were associated with patient prognosis. However, it may be difficult in critically ill patients because of the long examination time and for patients who have economical limitations due to the high price. The purpose of this study was to identify predictive factors for abnormal brain lesions on MRI in cases of normal brain findings on brain computed tomography (CT) in acute CO poisoning patients. This study was retrospectively analyzed at the tertiary emergency medical center located in Gyeonggi-do, Korea by prospectively collecting CO poisoning registry. From August 2016 to August 2019, 287 patients visited the hospital due to CO poisoning. Exclusion criteria included age under 18 years, being discharged against medical advice, no initial MRI data, no initial CT data, and having abnormal lesions on brain CT. Of the 103 patients included in the final study, the median age was 39 years old; 35 (34.0%) were male and 74 (71.8%) were intentionally exposed to CO. 27 (26.2%) patients had abnormal MRI findings. Based on multivariable analysis, elevated blood urea nitrogen (BUN) concentration (odds ratio, 1.165; 95% confidence interval, 1.037–1.308; p = 0.01) showed a significant association with abnormal MRI findings. The area under the curve was 0.753 (95% confidence interval, 0.636–0.869) in the receiver operating characteristic curve of BUN concentration for abnormal brain MRI presentations. Brain injury may be detected on brain MRI in acute CO poisoning patients even there was a normal brain CT scan. Our study revealed that elevated BUN concentration may be significantly correlated with abnormal MRI findings.

Identification of an Identical de Novo SCAMP5 Missense Variant in Four Unrelated Patients With Seizures and Severe Neurodevelopmental Delay.

Objective: To establish and broaden the phenotypic spectrum of secretory carrier membrane protein (SCAMP5) associated with epilepsy and neurodevelopmental delay. Methods: A Chinese patient was identified at the First Hospital of Peking University, and the three unrelated patients were recruited from two different countries (Italy and United States) through GeneMatcher. SCAMP5 pathogenic variants were identified by whole exome sequencing; clinical data of the patients were retrospectively collected and analyzed. Result: The onset age of seizures was ranged from 6 to 15 months. Patients had different types of seizures, including focal seizures, generalized tonic-clonic seizures and tonic seizure. One patient showed typical autism spectrum disorder (ASD) symptoms. Electroencephalogram (EEG) findings presented as focal or multifocal discharges, sometimes spreading to generalization. Brain magnetic resonance imaging (MRI) abnormalities were present in each patient. Severe intellectual disability and language and motor developmental disorders were found in our patients, with all patients having poor language development and were nonverbal at last follow-up. All but one of the patients could walk independently in childhood, but the ability to walk independently in one patient had deteriorated with age. All patients had abnormal neurological exam findings, mostly signs of extrapyramidal system involvement. Dysmorphic features were found in 2/4 patients, mainly in the face and trunk. All four unrelated patients were found to have the same heterozygous pathogenic SCAMP5 de novo variant (p. Gly180Trp). Conclusion: Epilepsy, severe developmental delay, abnormal neurological exam findings, with or without ASD or variably dysmorphic features and were common in patients with SCAMP5 variant. The onset time and type of seizure varied greatly. The EEG and brain MRI findings were not consistent, but diverse and nonspecific. The motor ability of patients with heterozygous SCAMP5 variant might have a regressive course; language development was more severely affected.

Identifying Clinical Clues in Children With Global Developmental Delay / Intellectual Disability With Abnormal Brain Magnetic Resonance Imaging (MRI).

Global developmental delay / intellectual disability are common pediatric conditions. Brain magnetic resonance imaging (MRI), although an important diagnostic tool in the evaluation of these patients, often requires general anesthesia. Recent literature suggests that unnecessary general anesthesia exposure should be avoided in early years because of possible long-term negative neurodevelopmental sequelae. This study sought to identify clinical clues associated with brain MRI abnormalities in children with global developmental delay / intellectual disability in an attempt to provide guidance to physicians on selecting patients who would benefit from an MRI. Retrospective chart review analysis was conducted for patients presenting to a pediatric neurology tertiary care center between 2014 and 2017 for a first clinic evaluation for global developmental delay / intellectual disability. Detailed clinical history and physical examination findings were analyzed and correlated with brain MRI findings. The majority (218/327, 67%) of children referred for evaluation of global developmental delay / intellectual disability underwent complete clinical and radiologic evaluations. Mean age was 37.9 months (±32.5 standard deviation) and 116 were males (53%). Motor deficits were predominant in most subjects (122/218, 56%). Abnormal MRI findings were observed in 153 children (70%), with the most prevalent abnormalities noted within the white matter (104/153, 68%), corpus callosum (77/153, 50%), and the hippocampus (50/153, 33%). Abnormal MRI findings were prevalent in children with predominant motor delay (84, 69%) and cognitive disability (3, 100%) as well as those with visual and hearing impairment (P < .05). The presence of facial dysmorphisms (57/71, P = .02); cranial nerve abnormalities (79/100; P = .007) and abnormal reflexes (16, P = .01) on examination also correlated significantly with increased MRI abnormalities.

Evaluation of Brain Magnetic Resonance Imaging (MRI) Findings of Neonates with Clinical Seizure Admitted to Yazd Shahid Sadoughi Hospital and its Effect on Diagnostic and Therapeutic Interventions of Newborns from 2015-2016

Introduction: In neonatal period, brain magnetic resonance imaging (MRI) is the best neuroimaging to find etiology of seizure. The aim of this study was to evaluate brain MRI findings of neonates with clinical seizure and its effect on diagnostic and therapeutic interventions of newborn. Methods: In a retrospective study, medical records and brain MRI findings of neonates with clinical seizure admitted to Neonatal Intensive Care Unit or Pediatric Ward of Shahid Sadoughi Hospital, Yazd, Iran from September 2018 and before were evaluated. The data were analyzed using SPSS version 16 software , the required indicators and tables were prepared and Fisher exact test and Chi-square test were used to determine the relationship between qualitative variables and independent t-test was used to compare the means in the two groups Results: Twenty-five girls and 38 boys were studied. The cause of seizures was found in 94% and the most common cause of congenital hypoxia was in 22 infants (35%). The most common type of seizure was tonic in 23 infants (36.5%) and the most common type of generalized seizure was in 47 infants (75%). Brain MRI was abnormal in 19 neonates (30%). Based on the MRI results, there was a change in therapeutic interventions (brain surgery) in four infants (6.3%) and in diagnostic interventions (metabolic tests) in 19 infants (30%). Abnormal brain MRI was more frequent in neonates by cesarean section (46%) than normal vaginal delivery (19%), (p= 0.01) and also neonates with partial seizure (37.5%) had an abnormal MRI than generalized seizure (21%), (p= 0.03). Mean of hospitalization days was longer in neonates with abnormal brain MRI (12.32±2.76 days) than neonates with normal MRI (8.57±2.82 days) (P = 0.02). Conclusion: Based on the results of this study, brain MRI might be useful in finding intracranial pathology that causes seizure in neonates by cesarean section to detect birth asphyxia and in newborns with partial seizure.

The prognosis of brain magnetic resonance imaging injury pattern for outcomes of hypothermia-treated infants.

Magnetic resonance imaging (MRI) can be a tool that allows the observation of structural injury patterns after cooling. The aim of this study was to determine the early pattern of brain injury in the MRIs of infants with hypoxic ischemic encephalopathy (HIE) after cooling and to search for any clinical factors related to abnormal MRI findings.The study retrospectively recruited 118 infants who were treated with therapeutic hypothermia (TH) between 2013 and 2016.Forty-three patients had normal brain MRI, and 75 had abnormal brain MRI findings. The TH-treated infants with abnormal brain MRI readings showed significantly more clinical seizures and the use of additional antiepileptic drugs (AEDs) than the normal MRI group. As a long-term outcome, more lesions in the basal ganglia and thalamus, posterior limb of internal capsule, or severe white matter lesions were associated with abnormal neurodevelopmental outcomes at 18 to 24 months of age.A higher frequency of clinical seizures and AED use were related to abnormal brain injury on MRI. A significant risk for poor long-term outcomes was found in the abnormal brain MRI group.

Acute flaccid myelitis outbreak through 2016-2018: A multicenter experience from Turkey.

We aim to describe the demographic characteristics, etiology, neurophysiology, imaging findings, treatment, prognosis, and prognostic factors of acute flaccid myelitis. The clinical data, laboratory test and, magnetic resonance imaging (MRI) results of pediatric patients diagnosed with acute flaccid myelitis according to the Centers for Disease Control criteria between August 1, 2016, and December 31, 2018, from 13 centers in Turkey were reviewed. Of the 34 cases identified, 31 were confirmed (91.2%). Eighteen patients (55.9%) were boys. The median patient age was 4 years (interquartile range 2.5-6.9 years). Most of the patients were admitted in 2018 (n=27). A preceding history of a febrile illness was reported in all patients, with a median of 4 days (interquartile range 3-7 days) before symptom onset. Thirty-one patients had T2 hyperintensity on spinal MRI, and 18 patients had cerebrospinal fluid pleocytosis. The most common infectious agents were entero/rhinoviruses (n=5) in respiratory specimens. All patients except one received immunotherapy either alone or in combination. Among 27 patients with follow-up data 24 had persistent weakness. Involvement of four limbs together with an abnormal brain MRI at onset were associated with a poor prognosis. The number of patients with acute flaccid myelitis increased since 2012, spiking with every 2-year interval, largely in the pediatric population. The median age decreases with every outbreak. Clinicians should be aware of the clinical picture for early collection of specimens and early start of rehabilitation programs. Further studies are needed to better characterize the etiology, pathogenesis, risk factors, and treatment of this rare condition.

Is Brain MRI Needed in Diagnostic Evaluation of Mild Intellectual Disability?

The purpose of our study was to suggest an imaging strategy and guidelines for the selection of the children with mild intellectual disability (ID) for magnetic resonance imaging (MRI), to avoid unnecessary imaging. The brain MRIs and patient reports of 471 children were reviewed for the imaging findings and ID severity. The correlation between the clinical and brain MRI findings was analyzed in the 305 children with mild ID. Thirty-eight (12.5%) of the children with mild ID had significant abnormal brain MRI findings. Thirty-five of these had other neurological symptoms or diseases in addition to ID, which were an indication for brain MRI. In the logistic regression analysis, seizures (in patients without an epilepsy diagnosis), epilepsy, movement disorders, dysmorphia, encephalitis, traumatic brain injury, and abnormal head size were statistically significant symptoms or comorbidities associated with abnormal MRI findings. Only three children (1.0%) with mild ID had a significant MRI finding without any other clinical symptoms or disease. Routine MRI in children with mild ID without specific neurological symptoms, dysmorphic features, or related diseases is not suggested for revealing an etiology of mild ID. Since children with ID usually need to be sedated for MRI, routine imaging in the diagnostic evaluation of mild ID should be carefully considered. Clinical examination, other symptoms, and related diseases should be carefully assessed to decide the need for MRI.

Multi‐institutional Evaluation of Radiologic Findings Associated With Pediatric Congenital Idiopathic Bilateral Vocal Fold Dysfunction

To report brain magnetic resonance imaging (MRI) and ultrasonography findings in pediatric patients with congenital idiopathic bilateral vocal fold dysfunction and analyze factors associated with its etiology and resolution. Case series with retrospective review. Tertiary care multi-institutional setting: Nationwide Children's Hospital, Indiana University, University of North Carolina, and Cleveland Clinic. Pediatric patients with congenital idiopathic bilateral vocal fold dysfunction were included in this review. Congenital idiopathic bilateral vocal fold dysfunction was identified in 74 patients from 2000 to 2018. Brain MRI scans were performed in all patients and ultrasonography in 30 (40.5%). Normal imaging results were most commonly found in patients born full-term (P < .0001) or via vaginal delivery (P < .01). Abnormal brain MRI and ultrasound results were found in 38 of 74 (51.3%) and 16 of 30 (53.3%), respectively. Type I Chiari malformation was not identified in any patient. No specific brain MRI or ultrasound abnormality was associated with patients' bilateral vocal fold dysfunction. Complete/incomplete bilateral vocal fold resolution occurred in 45 of 74 (60.8%) patients over the study interval and was not associated with brain MRI or ultrasound findings or birth complications but was associated with vaginal delivery (P = .02). Resolution rates were highest for patients with bilateral vocal fold paramedian paralysis (P = .05). In this multi-institutional study, no specific brain MRI or ultrasound abnormality was associated with patients' bilateral vocal fold dysfunction or subsequent resolution rates. While imaging is often performed to detect and treat any reversible causes of bilateral vocal fold dysfunction, in this series, imaging findings were heterogeneous and did not identify any treatable causes, such as type I Chiari malformation.

Correlation between early magnetic resonance imaging brain abnormalities in term infants with perinatal asphyxia and neuro developmental outcome at one year

Background: Hypoxic ischemic encephalopathy is an important cause of permanent brain damage in neonates with perinatal asphyxia. Magnetic resonance imaging (MRI) is valuable in predicting prognosis following HIE.Methods: Prospective observational cohort study was conducted in tertiary level referral hospital in term infants born with perinatal asphyxia. MRI brain was done between 5 to 14 days of age. Anthropometry and neurological examinations were recorded at birth, discharge and follow-up. Denver developmental screening test II was performed at follow up.Results: Out of 174 neonates born with PA, enrolled 64 underwent MRI brain. Out of these 14% had stage I, 70% stage II and 16 % stage III HIE as per Sarnat staging. At follow up, abnormalities in tone were noted in 36% infants, which included spastic quadriplegia in 34% and atonic cerebral palsy in 2%. DDST II was normal in 32 and suspect in 18 (36%) infants; with global developmental delay in 14 (28%) and predominantly motor development delay in 4 (8%). Abnormal lesions were seen in the corpus callosum in 34 (68%), posterior limb of internal capsule in 14 (28%), basal ganglia in 11 (22%), watershed region in 6 (12%), thalamus in 4 (8%) and corticospinal tract in 1 (2%) infants were associated with statistical significant poor neurodevelopment outcome p&lt;0.05. Diffusion weighted MRI showed abnormalities in the posterior limb of internal capsule (PLIC) in 27 (54%), BG in 8 (16%) and thalamus in 2 (4%) infants was associated with statistically significant poor neurodevelopmental outcome (NDO) (p&lt;0.05).Conclusions: Lesion in BG, thalamic region and PLIC in conventional MRI and abnormality in DW imaging in PLIC and BG were found to correlate with poor NDO at one year of life.