[Diagnostic aspects of cerebral arterial occlusion in children (author's transl)].
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Adolescent↗
Biomedical subjects
M O Livet
Publications and source records attributed to M O Livet.
[Evaluation of one year experience with cerebral tomodensitometry in pediatric neurology].
Cerebral tomography allows the delineation of areas modified by edema or necrosis, the visualization of calcifications undetectable by standard x-ray examination, extra- or intra-cerebral blood effusions and neoformations of the cerebrum or of its envelopes. It also reveals slight or localized cerebral atrophies that other neuro-radiologic techniques sometimes failed to detect. It appears therefore worthwhile to reconsider pediatric neurology according to this new type of investigation. Its sole difficulty in young children, is the requirement of a half hour immobility, best obtained by general anesthesia. However, the rapid improvements of this technique will probably permit to overcome this slight drawback.
Brain Diseases↗
Giant axonal neuropathy. Involvement of peripheral nerve, myenteric plexus and extra-neuronal area.
A case of giant axonal neuropathy in a 8 years old child is reported by light and electron microscopy. Clinically, this case is strikingly similar to the rare previous reports and characterized by a distal neuropathy, CNS symptoms and tightly curled hair. Giant axons were found in the sural nerve but had been absent at the onset of the illness. An increase in the number of neurofilaments was found in the axons and neurons of the myenteric plexus. The number of microfilaments was also increased in various types of cells namely Schwann and endothelial cells and fibroblasts: This suggests that the metabolic disorder, probably inborn and genetic, does not only affect the nervous system.
Axons↗
[Acquired craniostenoses].
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Child, Preschool↗
[Schilder's disease with adrenal insufficiency (adreno-leukodystrophy). Apropos of 5 cases].
Five cases of Schilder's disease with adrenal insufficiency are reported (adrenoleucodystrophy) one of whom has a first cousin with Addison's disease. The principle clinical features of the disorder are outlined and particularly the great variability in the severity of the adrenal insufficiency. The current understanding of this disorder is reviewed.
Adolescent↗
[Rickets. A rare complication of anti-epileptic treatments. Report of two cases in children].
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Anticonvulsants↗
Prader-Willi syndrome: diagnostic strategy with a cytogenetic and molecular approach.
Prader-Willi syndrome (PWS) is a disorder characterized by neonatal hypotonia with poor suck, mild to moderate mental retardation, obesity beginning after 3 yr of age, hypogonadism and characteristic facial features. High resolution cytogenetic studies showed a deletion of the proximal chromosome 15q(q11-q13) region in approximately 50%. Interestingly, the same deletion was described in another distinct mental disorder: the Angelman syndrome (AS). This deletion was confirmed by molecular analyses, and a new mechanism was reported: uniparental disomy (maternal in PWS and paternal in AS) strongly implicate genomic imprinting in this chromosomal region. The principal aim of our group is to apply cytogenetic and molecular biology techniques to perform diagnosis and genetic counselling. Patient studies were usually based on high resolution cytogenetic analysis, quantitative Southern blotting (with D15S9, D15S11, D15S10, D15S12 loci) and dinucleotide repeat polymorphism assay by polymerase chain reaction (PCR) (IR4 .3R and GABARB3). The combination of these different methods allowed us to propose a diagnostic strategy for PWS.
Angelman Syndrome↗
[A case of cerebral lipidosis with an atypical presentation (author's transl)].
The authors have reported a case of cerebral lipidosis (type Jansky-Bielschowsky) in which the presenting features appeared at the age of 2 years 10 months, and consisted of clonic seizures followed by atonic attacks and atypical absences. The association of seizures, severe mental disturbances and EEG abnormalities with an interseizure abnormality (diffuse slow waves) led to an initial misdiagnosis of the Lennox-Gastaut syndrome. The diagnosis which is suspected on the basis of clinical features (epilepsy, mental deterioration, pyramidal features), EEG signs (spikes on photic stimulation at low frequency or isolated) and ophthalmological investigations (ERG reduced response, abnormal VERs) was eventually made by rectal biopsy.
Cerebral Cortex↗
Phenotype-genotype correlation in 20 deletion and 20 non-deletion Angelman syndrome patients.
Angelman syndrome (AS) is a neurodevelopmental disorder caused by the absence of a maternal contribution to chromosome 15q11-q13. There are four classes of AS according to molecular or cytogenetic status: maternal microdeletion of 15q11-q13 (approximately 70% of AS patients); uniparental disomy (UPD); defects in a putative imprinting centre (IM); the fourth includes 20-30% of AS individuals with biparental inheritance and a normal pattern of allelic methylation in 15q11-q13. Mutations of UBE3A have recently been identified as causing AS in the latter group. Few studies have investigated the phenotypic differences between these classes. We compared 20 non-deletion to 20 age-matched deletion patients and found significant phenotypic differences between the two groups. The more severe phenotype in the deletion group may suggest a contiguous gene syndrome.
Adolescent↗
Startle response: epileptic or non-epileptic? The case for "flash" SMA reflex seizures.
A 19-year-old woman complained of long-standing, frequent, debilitating brusque movements triggered by unexpected stimuli. She was neurologically normal and neuroimaging was also normal. Conspicuous startle reactions were easily reproduced under EEG and video monitoring: the interictal EEG was normal, the ictal recordings doubtful; clinically, the startle reaction was asymmetric, with elevation of the left limbs. The diagnosis of hyperekplexia and startle epilepsy were discussed. We learned that she had been evaluated at age 3-4 months for spontaneous, generalised tonic-clonic seizures and "infantile spasms", in fact for early-onset startle reactions triggered by noise or contact, in association with prominent EEG changes. A full remission had been achieved under ACTH therapy, but the startle reactions had reappeared at around age six. The patient was successfully treated with carbamazepine. The history, clinical and neurophysiological data led us to discuss the diagnosis of hyperekplexia and startle epilepsy. We concluded that the patient had an unusual form of cryptogenic focal epilepsy originating from the supplementary motor area, presenting as strictly stimulus-triggered "flash" seizures.
Adult↗
[Diagnostic aspects of cerebral arterial occlusion in infants and children (author's transl)].
The authors have studied the bases of the clinical and CT diagnosis of cerebral arterial occlusion in children from a series of 16 cases. The sequential evolution of the CT appearance seems characteristic depending on the time elapsed since the onset. Contrast enhancement, concerns mainly the grey matter, is maximum during the second and third weeks and should be looked for during this period. The aetiology remains usually hypothetic. Some data, including the angiographic aspect of "endarteritis" may suggest an infectious pathogeny.
Adolescent↗
[Ataxia-opsoclonus-myoclonus syndrome].
The ataxia-opsoclonus-myoclonus syndrome that was well individualized by Kinsbourne is mostly observed in young children (less than three years old in 90 percent of the cases). From six personal cases, and from a review of ninety cases of the literature, the clinical and etiological features, as well as the evolution of the syndrome, are studied. Prodromes (infectious and digestive manifestations) and comportmental changes usually precede the sudden onset of the clinical triad. Neurologic complementary investigations are typically normal during the acute phase. The frequent association (46 percent of the cases) of this syndrome to a neuroblastoma (usually thoracic) makes it very particular from the etiological point of view. The evolution is identical whatever the type ("isolated" or "tumoral"). Corticotherapy (ACTH or corticoids) is efficient in 60 percent of the cases. But recurrences and cerebral sequelae (mental deficiency and speech disorders) are frequent.
Adrenal Cortex Hormones↗
[Generalized epilepsy disclosing medium-chain-acyl-CoA dehydrogenase deficiency].
BACKGROUND: Medium-chain acyl-CoA dehydrogenase (MCAD) deficiency is the most common inherited defect of fatty acid beta-oxidation. As it causes life-threatening symptoms, it is mandatory to diagnose deficiencies of this enzyme in families. CASE REPORT: A boy was admitted at the age of 3 months because of a recent attack of generalized seizures. His parents were second cousins and one of his 2 sisters, 6 years old, suffered from epilepsy. At admission, the patient had moderate hepatomegaly; he was given clonazepam and phenytoin because of persistent status epilepticus. He developed a fever (temp.: 39 degrees) and a rash 24 hours later. A viral etiology was suggested by CSF contents of 104 cells/mm3 and 1 g/l protein. The patient was given aciclovir. Blood glucose, transaminases, ammonia, lactate, pyruvate and amino acids levels were normal. Analysis of urine by GC-MS revealed a large lactate peak and dicarboxylic acids, unsaturated dicarboxylic acids, hydroxyhexanoate, 7-hydroxyoctanoate, hexanoylglycine and suberylglycine. This profile indicated a MCAD deficiency. The plasma contained partially oxidized medium-chain fatty acids, such as octanoic acid and especially 4-decenoic acid. the diagnosis was confirmed by a phenylpropionate loading test and specific enzyme assay in fibroblasts. Molecular studies identified a G 985 mutation in the patient and revealed that the parents were heterozygotes for the mutation. The condition of the patient at the age of 18 months is excellent; he has a regular, adequate caloric intake and avoids fasting. He has not taken anti-epileptic drugs for the past 6 months. CONCLUSION: There is no typical clinical presentation of MCAD-deficiency; the most frequent features are vomiting and lethargy. Episodic hypoglycemia has been reported, but hypoglycemia was not found in our patient. Molecular studies will allow neonatal diagnosis of the next affected siblings.
Acyl-CoA Dehydrogenase↗