Neuroimaging In Children Research Articles

The roles of electroencephalography and neuroimaging in children with holoprosencephaly

ABSTRACT We analyze the respective roles of neuro‐imaging and EEG in the assessment of 11 children with holoprosencephaly and epilepsy. Seizures were present in seven patients (64%) ; six were treated with antiepileptic drugs ; five had intractable epilepsy. Two of the patients with intractable epilepsy became seizure‐free under polytherapy. Fourteen EEG recordings were performed in eight patients. The abnormal EEG findings included slow waves, focal epileptiform discharges, slow spike‐and‐wave complexes, hypsarrhythmia, frontal fast activity, fronto‐occipital gradients of amplitudes (posterior amplitude attenuation), lack of photic driving, periodic discharges, and extremely large amplitudes. A fronto‐occipital gradient was found only in alobar and semilobar holoprosencephaly (HPE), while hypsarrhythmia only in lobar HPE. Lack of photic driving was found only in alobar HPE. All EEGs showed diffuse slow waves, and all patients had severe developmental delay. The Deep Gray Score (DGS) in neuroimaging studies, thought to predict clinical outcome, was irrelevant given the presence and intractability of the epilepsies. Patients with higher DGS, nonetheless, tended to have higher mortality rate. In conclusion, EEG evaluation provides additional functional information to neuroimaging studies in the assessment of neurological outcome in patients with HPE. With a more mature and well‐formed cerebrum, as found in the lobar and semilobar types, the possibility of hypsarrhythmia and photic driving increased, while that of fronto‐occipital gradients decreased.

Causes, Types, and Outcome of Holoprosencephaly

Recent advances in genetics and neuroimaging of children with holoprosencephaly (HPE) are reviewed from Stanford University School of Medicine, CA.

Biotinidase deficiency: clinical and MRI findings consistent with myelopathy

Spastic paraparesis has been described in children with biotinidase deficiency and onset in later childhood and early adolescence. A 3-year-old male with biotinidase deficiency presented with rash, ataxia, and paraparesis and magnetic resonance imaging findings of myelopathy. Improvement occurred after treatment with biotin. Myelopathy should be added to the features that may be found on clinical examination and neuroimaging of children with biotinidase deficiency, regardless of age of presentation.

Neuroimaging for New-Onset Afebrile Seizures

The prevalence of clinically significant abnormal neuroimaging in children presenting in the emergency department (ED) with new-onset afebrile seizures (ASZ) was determined in a series of 500 consecutive cases seen over a 34-month period between October 1996 and July 1998 at the Children’s Hospital, Boston, MA.

The role of emergent neuroimaging in children with new-onset afebrile seizures.

The objectives of this study were 1) to determine the frequency of clinically significant abnormal neuroimaging in children coming to the emergency department (ED) with new-onset afebrile seizures (ASZ), and 2) to identify children at high or low risk for clinically significant abnormal neuroimaging. Five hundred consecutive cases of new-onset ASZ seen in the ED of a tertiary care children's hospital were reviewed. Neuroimaging reports were categorized as normal, clinically insignificant abnormal, or clinically significant abnormal. Recursive partition analysis was used to identify clinical variables that separated children into high- and low-risk groups for clinically significant abnormal neuroimaging. Ninety-five percent of patients (475/500) with new-onset ASZ had neuroimaging. Clinically significant abnormal neuroimaging was noted in 8% (95% confidence interval [CI]: 6, 11; 38/475) of patients. Recursive partition analysis identified 2 criteria associated with high risk for clinically significant abnormal neuroimaging: 1) the presence of a predisposing condition, and 2) focal seizure if <33 months old. Of the high-risk patients, 26% (95% CI: 17, 35; 32/121) had clinically significant abnormal neuroimaging compared with 2% (95% CI: 0.6, 3.7; 6/354) in the low-risk group. In this large, retrospective review of children with new-onset ASZ, clinically significant abnormal neuroimaging occurred with relatively low frequency. Emergent neuroimaging should be considered, however, for children who meet high-risk criteria. Well-appearing children who meet low-risk criteria can be safely discharged from the ED (if follow-up can be assured) without emergent neuroimaging, because their risk for clinically significant abnormal neuroimaging is appreciably lower.

Visual impairment in infancy: impact on neurodevelopmental and neurobiological processes

Visual impairment in infancy: impact on neurodevelopmental and neurobiological processes

The utility of neuroimaging in the evaluation of children with migraine or chronic daily headache who have normal neurological examinations.

To assess the utility of neuroimaging in the evaluation of children presenting with two of the most common forms of headache, migraine and chronic daily headache, and to determine the utility and pathological yield of neuroimaging in specific headache syndromes in children whose neurological examinations are normal. We retrospectively reviewed the medical records of patients coded for headache (ICD 784) in the Pediatric Neurology Clinic at Children's Hospital of the King's Daughters between 1997 and 1999. The age range considered was between 6 and 18 years. The study focused on the two most common types of headache, uncomplicated migraine and chronic daily headache. Only patients with normal physical and neurological examinations were considered in this analysis. Three hundred two patients were coded for headache within the defined age group. One hundred seven (35.4%) patients fulfilled IHS-R criteria as having uncomplicated migraine with a normal examination, and 30 (9.9%) patients fulfilled criteria for chronic daily headache. Twenty-nine (9.6%) patients presented with migrainelike symptoms, and 6 (2.0%) presented with chronic daily symptoms, but had neurological abnormalities present on examination. The remainder of the patients with headache had the following etiologies: 50 (16.6%) with secondary headache, 22 (7.3%) with complicated migraine, 20 (6.6%) with posttraumatic headache, 13 (4.3%) with seizure-related headache, 11 (3.6%) with brain tumors, 10 (3.3%) with tension-type headache, and 4 (1.3%) with pseudotumor cerebri. Of the 107 patients with migraine, 42 (39.3%) received CT scans; 2 (4.8%) of which were considered "abnormal." One of the abnormalities was an arachnoid cyst and the other was a dilated Virchow-Robin space. Twelve (11.2%) patients with migraine received an MRI, 2 (16.7%) of which were considered abnormal. Both of the abnormal findings were Chiari type I malformations. Of the 30 patients with chronic daily headache, 17 (56.7%) received CT scans, 3 (17.6%) of which were considered abnormal. The abnormalities consisted of a maxillary opacification, a mucous retention cyst, and an occult vascular malformation. Eight (26.7%) of the patients with chronic daily headache had an MRI, 2 (25.0%) of which were abnormal. One of the abnormalities was a Chiari I malformation, and the other was an occult vascular malformation. The yield of neuroimaging in children with uncomplicated migraine and normal neurological examination was 3.7%. The yield in children with chronic daily headache and normal neurological examination was higher at 16.6%. The abnormalities discovered included arachnoid cysts, Chiari I malformations, sinus disease, occult vascular malformations and "dilated Virchow-Robin spaces." While none of the neuroimaging findings were apparent clinically, their discovery did not influence the diagnosis, management, or outcome of the patients. None of the abnormalities necessitated surgical intervention or were associated with the headache presentation. Therefore, neuroimaging is not warranted in children and adolescents with defined clinical headache syndrome diagnoses whose neurological examinations are normal.

Value of Routine Neuro-Imaging in Children with Cerebral Palsy

Value of Routine Neuro-Imaging in Children with Cerebral Palsy

Volumetric neuroimaging in children with neurodevelopmental disorders--mapping the brain and behavior.

The recent volumetric neuroimaging studies in children with fragile X syndrome, Down syndrome (DS), Rett syndrome (RS), and Tourette syndrome (TS) were reviewed. Neuroimaging studies and cognitive and behavioral phenotypes pertinent to each disorder were reviewed within the context of current knowledge of their neurobiological mechanisms. The mainly involved brain regions in fragile X syndrome are the cerebellar vermis, temporal areas, and the caudate nucleus which may be related to autistic tendency, problems of memory and language and deficits in executive function, respectively. The preferential involvement of frontal lobe, cerebellum and mesial temporal areas may correspond to the selective language and speech deficits in DS children. There was significantly generalized cerebral volume reduction with greater loss of gray matter in comparison to white matter, consistent with the extensive clinical features of RS. Right side predominance of basal ganglia supported the suggestion that the basal ganglia is related to pathogenesis of TS, which may also be related to the impaired executive function and the absence of functional asymmetry. Further prospectives for integrating neuroanatomic findings and neurobehavioral studies also were discussed.

Neuroimaging of children with partial seizures

The predictive value of abnormal neurological findings on neuroimaging (NI) of children with partial seizures (PS) was studied. The sample comprised 143 children and adolescents with PS from 1979 to 1996. Fifty patients had the following abnormal NI findings: diffuse atrophy and porencephalic cyst (5.6% each), hemiatrophy, tumors, neurocutaneous syndrome brain lesions, and dysgenesis (4.2% each), and arachnoid cyst and hydrocephalus (2.1% each). There were significantly more NI abnormalities among those with simple PS than among the other groups of complex PS or PS with secondary generalization. All cases of porencephalic cyst (n = 8), and hemiatrophy (n = 6) were in the hemiparetic group, all cases of tumor (n = 6) were in the normal group, while most cases of diffuse atrophy were in the mentally retarded group. Patients with abnormal NIs had a significantly earlier age of seizure onset than the others. The chance of finding a treatable abnormality in neuroimaging was 5% for tumors and 2% for arachnoid cysts in the group of patients with PS and normal neurological findings. Neither an abnormality detected in a neurological examination nor the type of seizure are predictive parameters for suggesting the presence of a resectable brain tumor. All patients with newly diagnosed PS should undergo an MRI.

Neuroimaging of children with partial seizures

Neuroimaging of children with partial seizures

Children with headache: clinical predictors of surgical space-occupying lesions and the role of neuroimaging.

To determine clinical predictors useful in differentiation of surgical lesions from medically treated disorders and the role of neuroimaging in children with headache. MATERIALS' AND METHODS: In a 4-year retrospective study, 315 patients with headache and no known neurologic disorder underwent brain magnetic resonance (MR) imaging. Sixty-nine patients also underwent brain computed tomography (CT). Clinical data were correlated with findings from MR imaging and CT and the final diagnosis by means of logistic regression. Thirteen (4%) patients had surgical space-occupying lesions. Seven independent multivariate predictors of a surgical lesion were identified. Sleep-related headache and no family history of migraine were the strongest predictors. Other predictors included vomiting, absence of visual symptoms, headache of less than 6 months duration, confusion, and abnormal neurologic examination findings. A positive correlation between number of predictors and risk of surgical lesion was noted (P < .0001). No difference between MR imaging and CT was noted in detection of surgical space-occupying lesions, and there were no false-positive or false-negative surgical lesions detected with either modality on the basis of clinical follow-up. Children at high risk on the basis of these criteria usually require neuroimaging, while children at low risk may be safely followed up clinically without neuroimaging.

The Role of Neuroimaging in Children with Headache

The Role of Neuroimaging in Children with Headache

MRI findings in children with neurofibromatosis type 1: a prospective study

To determine the frequency and nature of MRI lesions in children with neurofibromatosis type I (NF1), 50 patients aged 8 to 16 years were evaluated prospectively with cranial MRI. Forty-one children were asymptomatic with respect to central nervous system pathology, and 50% were macrocephalic. Sixteen patients (32%) had normal MRI examinations. Thirty-two patients (64%) had high intensity lesions on T2-weighted images and 16 patients (32%) had hyperintense lesions on T1-weighted images. Seven patients (14%) had ventricular dilatation (associated with increased intracranial pressure in 2) and 11 patients (22%) had optic pathway lesions (optic glioma in 7). MRI was superior to CT in differentiating optic sheath thickening and optic nerve tortuosity from optic glioma in four patients. An intracranial tumour (ependymoma) and sphenoid wing dysplasia were evident in individual patients. Findings previously unreported in NF1 included an aqueductal web resulting in hydrocephalus, intraocular neurofibroma resulting in retinal detachment, and asymptomatic enlargement of the septum pellucidum. T1 and T2 signal abnormalities in isolation were not associated with neurological deficits or the occurrence of macrocephaly, and all lesions that required intervention were suspected clinically. Macrocephaly in the absence of increased intracranial pressure or accelerated head growth is not an indication for neuroimaging in children with NF1. However, the majority of children (68%) had disease-specific abnormalities and thus MRI may provide a useful adjunct to clinical evaluation in the diagnosis of equivocal cases.

Randomised double-blind clinical trial of intermediate- versus high-dose chloral hydrate for neuroimaging of children

Randomised double-blind clinical trial of intermediate- versus high-dose chloral hydrate for neuroimaging of children

Determinant of the optimal hematocrit.

ARTICLESDeterminant of the optimal hematocritJ. W. Crowell, and E. E. SmithJ. W. Crowell, and E. E. SmithPublished Online:01 Mar 1967https://doi.org/10.1152/jappl.1967.22.3.501MoreSectionsPDF (734 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat Previous Back to Top Next Download PDF FiguresReferencesRelatedInformation Cited ByCalculating brain perfusion of primatesJournal of Human Evolution, Vol. 128Seeking the optimal hematocrit: May hemorheological modelling provide a solution?Clinical Hemorheology and Microcirculation, Vol. 69, No. 4Evidence-Based Emergency Neuroimaging in Children and Adults with Sickle Cell Disease and Symptoms of Stroke29 March 2018A Mountain or a Plateau? Hematological Traits Vary Nonlinearly with Altitude in a Highland LizardPhysiological and Biochemical Zoology, Vol. 90, No. 6Influence of feeding hematocrit and perfusion pressure on hematocrit reduction (Fåhraeus effect) in an artificial microvascular network6 November 2017 | Microcirculation, Vol. 24, No. 8Comparison of various approaches to calculating the optimal hematocrit in vertebratesHeiko Stark, and Stefan Schuster1 August 2012 | Journal of Applied Physiology, Vol. 113, No. 3Increased cardiac output and microvascular blood flow during mild hemoconcentration in hamster window modelJudith Martini, Amy G. Tsai, Pedro Cabrales, Paul C. Johnson, and Marcos Intaglietta1 July 2006 | American Journal of Physiology-Heart and Circulatory Physiology, Vol. 291, No. 1Catheter-based impedance measurements in the right atrium for continuously monitoring hematocrit and estimating blood viscosity changes; an in vivo feasibility study in swineBiosensors and Bioelectronics, Vol. 19, No. 12Optimal hemoglobin concentration and high altitude: a theoretical approach for Andean men at restFrancisco C. Villafuerte, Rosa Cárdenas, and Carlos Monge-C1 May 2004 | Journal of Applied Physiology, Vol. 96, No. 5The Use of Blood Products in ShockCritical Care Clinics, Vol. 8, No. 2Variations in function and design: Testing symmorphosis in the respiratory systemRespiration Physiology, Vol. 87, No. 3Secondary polycythemia does not increase the risk of perioperative hemorrhagic or thrombotic complicationsJournal of Clinical Anesthesia, Vol. 3, No. 2Blood viscosity and hematocrit in the estuarine crocodile, Crocodylus porosusComparative Biochemistry and Physiology Part A: Physiology, Vol. 99, No. 3Optimal hematocrit theory during activity in the bullfrog (Rana catesbeiana)Comparative Biochemistry and Physiology Part A: Physiology, Vol. 99, No. 1-2Blood viscosity and circulatory shockIntensive Care Medicine, Vol. 15, No. 2Oxygen transport in low cardiac output statesJournal of Critical Care, Vol. 2, No. 4Systemic oxygen transport in patients with congenital heart disease.Circulation, Vol. 75, No. 2Oxygen transport and oxygen consumption vs. cardiac output at different haematocrits30 June 2016 | Perfusion, Vol. 2, No. 1Sports anemia: A review of the literature23 April 2016 | The American Journal of Sports Medicine, Vol. 14, No. 2Plasma viscosity in ischemic heart diseaseAmerican Heart Journal, Vol. 108, No. 3Optimal hematocrit for oxygenation of canine intestine.Circulation Research, Vol. 51, No. 2Effects of Hematocrit Variations on Cerebral Blood Flow and Oxygen Transport in Ischemic Cerebrovascular Disease29 June 2016 | Journal of Cerebral Blood Flow & Metabolism, Vol. 1, No. 4The hematological response to hypoxia in growing guinea pigs is blunted during concomitant cold stressComparative Biochemistry and Physiology Part A: Physiology, Vol. 70, No. 3Oxygen transport during progressive hypoxia in high-altitude and sea-level waterfowlRespiration Physiology, Vol. 39, No. 2Hematology and red cell morphology in guinea pigs acclimated to chronic hypoxia during growthComparative Biochemistry and Physiology Part A: Physiology, Vol. 67, No. 2Changes in blood viscosity and plasma proteins in myocardial infarctionResuscitation, Vol. 5, No. 3Hemodynamic effects of slow and rapid defibrination with defibrizyme, the thrombin-like enzyme from venom of the timber rattlesnakeAmerican Heart Journal, Vol. 90, No. 1Haematological adjustments with diurnal changes in body temperature in a lizard and a mouseComparative Biochemistry and Physiology Part A: Physiology, Vol. 51, No. 1Potential significance of plasma viscosity and hematocrit variations in myocardial ischemiaAmerican Heart Journal, Vol. 87, No. 2Vascular resistance and oxygen transport as functions of haematocritResuscitation, Vol. 3, No. 3 More from this issue > Volume 22Issue 3March 1967Pages 501-504 Copyright & PermissionsCopyright © 1967 the American Physiological Societyhttps://doi.org/10.1152/jappl.1967.22.3.501PubMed6020234History Published online 1 March 1967 Published in print 1 March 1967 Metrics