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Biomedical subjects

O Flodmark

Publications and source records attributed to O Flodmark.

At least 19 recordsLinked to original sources
PubMed2003

Posterior ocular malformations in children: somatic, neuroradiological and cognitive aspects.

AIM: To investigate associated neurological, endocrinological and cognitive dysfunctions in children with visual impairment caused by optic nerve hypoplasia or optic nerve/fundus coloboma and/or microphthalmus. METHODS: Forty children born between 1990 and 1998 were assessed by neurological examination, re-evaluation of neuroradiological investigations, review of medical records and examination of cognitive levels. RESULTS: Neurological dysfunctions (epilepsy and/or motor impairment) were found in 13/28 children with optic nerve hypoplasia and in 3/12 children with coloboma/microphthalmus. The optic pathways were thin in 22/24, an abnormal posterior pituitary gland and/or thin infundibulum was found in 16/22 and absence of septum pellucidum in 14/27 children with optic nerve hypoplasia. Other types of cerebral abnormalities occurred in 9/26 children. Among children with coloboma/microphthalmus, the optic pathways were thin in 4/8 children but none had pituitary or cerebral midline abnormalities. Sixteen children with optic nerve hypoplasia were receiving hormone substitution but none of the children with coloboma/microphthalmus. Thirteen of the 16 children with optic nerve hypoplasia and with an abnormal pituitary region had endocrinological deficiencies. Mental retardation was found in 9/24 of the children with optic nerve hypoplasia and in 5/10 of the children with coloboma/microphthalmus. CONCLUSION: Endocrinological. neurological and neuroradiological defects seem more common in children with optic nerve hypoplasia than in children with coloboma. A pituitary region that appears abnormal in magnetic resonance imaging seems to predict endocrinological deficits in children with optic nerve hypoplasia.

Blindness↗
PubMed2003

Optic disc morphology may reveal timing of insult in children with periventricular leucomalacia and/or periventricular haemorrhage.

AIMS: To evaluate the relation between optic disc morphology and timing of periventricular white matter damage, defined as either periventricular leucomalacia (PVL) or periventricular haemorrhage (PVH), as estimated by neuroradiology. METHODS: 35 children with periventricular white matter damage who had had neuroradiology performed and ocular fundus photographs taken had their photographs analysed by digital image analysis and compared with a control group of 100 healthy full term children. Timing of brain lesion was estimated by analysis of the brain lesion pattern on neuroradiological examinations (magnetic resonance imaging or computed tomography). RESULTS: Four of 35 children had a small optic disc area; these four children had a brain lesion estimated to have occurred before 28 weeks of gestation. Nine of 11 children with a large cup area had a PVL/PVH estimated to have occurred after 28 weeks of gestation. The children with PVL/PVH had a significantly larger cup area (median 0.75 mm(2)) than the control group (median 0.33 mm(2)) (p = 0.001) and a significantly smaller neuroretinal rim area (median 1.58 mm(2)) than the controls (median 2.07 mm(2)) (p = 0.001). CONCLUSION: In a child with PVL/PVH and abnormal optic disc morphology, the possibilities of timing of the lesion should be considered.

Case-Control Studies↗
PubMed2002

Visual and perceptual characteristics, ocular motility and strabismus in children with periventricular leukomalacia.

The immature visual system is vulnerable to adverse events. Periventricular leukomalacia (PVL), an end-stage lesion after hypoxia-ischemia at gestational age 24-34 weeks affecting the visual radiation, has become a principal cause of visual impairment in children. Cerebral visual dysfunction caused by PVL is characterized by delayed visual maturation, subnormal visual acuity, crowding, visual field defects, and visual perceptual-cognitive problems. Magnetic resonance imaging is the method of choice for diagnosing this brain lesion, which is associated with optic disk abnormalities, strabismus, nystagmus, and deficient visually guided eye movements. Children with PVL may present to the ophthalmologist within a clinical spectrum from severe visual impairment in combination with cerebral palsy to only early-onset esotropia, normal intellectual level and no cerebral palsy. Optimal educational and habilitational strategies need to be developed to meet the needs for this group of children.

Adolescent↗
PubMed2001

Occlusive hydrocephalus in congenital myotonic dystrophy.

A case of congenital myotonic dystrophy is reported which was complicated by the development of a hydrocephalus that needed ventricular-peritoneal shunting at the age of 4 months. Although dilatation of cerebral ventricles is a common feature in these patients, an occlusive hydrocephalus has not so far been reported.

Brain↗
PubMed2001

Association between visual impairment and functional and morphological cerebral abnormalities in full-term children.

PURPOSE: To characterise the nature and degree of ocular disorders and cerebral morphological and functional abnormalities in a population-based group of visually impaired full-term pre-school children. METHODS: Forty-five children who were born at full-term between 1989 and 1995 in Värmland, Sweden, were reported as being visually impaired. An ophthalmological examination was performed and clinical data regarding mental development and neurological disease were obtained for all children. Cerebral imaging was performed in 35 children. RESULTS: Twenty-six per cent of the children were found to have ocular disorders only. Forty-two per cent had cerebral morphological abnormalities, verified by cerebral imaging, and 65% had signs of cerebral functional abnormalities. In total, 74% were found to have cerebral morphological and/or cerebral functional abnormalities. CONCLUSION: The majority of children with visual impairment, including children with ocular disorders, were found to have cerebral morphological and/or cerebral functional abnormalities. We suggest that any child with visual impairment should therefore undergo cerebral imaging and be examined by a paediatrician in order to establish the correct diagnosis.

Brain↗
PubMed1998

Periventricular leukomalacia causes visual impairment in preterm children. A study on the aetiologies of visual impairment in a population-based group of preterm children born 1989-95 in the county of Värmland, Sweden.

PURPOSE: To determine the causes of visual impairment in a population-based group of visually impaired preterm children. METHODS: Ophthalmological examination and magnetic resonance imaging or computed tomography of the brain were performed in all visually impaired preterm children born 1989-95 in Värmland. RESULTS: Ten of 18 children had periventricular leukomalacia affecting the optic radiation, six had other lesions or malformations in the posterior visual pathways/cortex, but no child had visually impairing retinopathy of prematurity. CONCLUSION: We conclude that cerebral lesions or malformations are common causes of the visual functional deficit in visually impaired children born preterm. Brain damage should be suspected in a prematurely born child who presents with either of the signs: fixation difficulties, strabismus or nystagmus.

Adult↗
PubMed1998

Nystagmus in periventricular leucomalacia.

BACKGROUND/AIMS: Periventricular leucomalacia (PVL) is a lesion in the immature brain involving the optic radiation. Children with PVL have visual problems including crowding, visual field defects, strabismus, and visual perceptual/cognitive deficits, together with nystagmus. They often have optic nerve hypoplasia seen either as small discs or as large cupping of normal sized optic discs. This study aimed to perform eye movement recordings in a group of children with PVL in order to characterise and classify the nystagmus. METHODS: 19 children with PVL on cerebral imaging underwent eye movement recordings with the Ober-2 infrared reflection technique. RESULTS: 16 of the 19 subjects had horizontal nystagmus. CONCLUSION: The present study shows that nystagmus is commonly seen in children with PVL.

Adolescent↗
PubMed1997

Large cups in normal-sized optic discs: a variant of optic nerve hypoplasia in children with periventricular leukomalacia.

OBJECTIVE: To evaluate optic disc morphologic features in children with periventricular leukomalacia (PVL). PATIENTS AND METHODS: Seventeen children with PVL (patient group) were compared with 17 sex- and age-matched, full-term healthy control children (control group). Clinical ophthalmological examination and digital image analysis of fundus photographs were performed in all children. In children with PVL, cerebral imaging was performed. RESULTS: Children with PVL had larger optic disc cupping (P<.02) than did control children. A large proportion of the children with PVL had strabismus, nystagmus, and restricted visual fields. CONCLUSION: Our study indicates that optic nerve hypoplasia in children with PVL is often associated with a normal-sized optic disc with a large cup. This unusual form of optic nerve hypoplasia most likely results from transsynaptic degeneration of optic axons caused by the primary bilateral lesion in the optic radiation.

Adolescent↗
PubMed1997

Diagnosis of intracranial lesions in very-low-birthweight infants by ultrasound: incidence and association with potential risk factors.

This study was designed to determine the frequencies of germinal matrix and ventricular haemorrhages as well as lesions in the white matter diagnosed by ultrasonography. In subsequent studies the effects of perinatal brain lesions on the cognitive and motor development of preterm children will be presented. Lesions of the white matter are probably more damaging than intraventricular and subependymal bleeds. Therefore, a modified classification of the lesions was used, clearly separating bleeds from white matter pathology. The study includes 291 infants with a body weight of < or = 1500 g consecutively admitted to the neonatal intensive-case unit at Karolinska Hospital from 1988 to 1993. Fifty-four (18.9%) died before 6 months. Two hundred and sixty-three infants were examined using ultrasound. Pathology due to bleeding was classified into three grades (B1-3) similar to Papile's first three grades. Pathology in periventricular white matter was classified into four groups (W1-4): W1 = subtle and We = distinctive white matter echodensities; W3 = cyst formation; W4 = large, intense echodensity. Forty-nine patients had abnormalities in the periventricular white matter (15 W1, 12 W2, 11 W3 and 11 W4) and 58 had subependymal (B1 = 29) or ventricular bleeding without (B2 = 13) or with dilatation (B3 = 16). Ventilator treatment was significantly associated with both B and W lesions. Low gestational age, low birthweight, small for gestational age, pre-eclampsia and caesarean section were significantly associated with B lesions whereas asphyxia, surfactant treatment, male patient sex and outborn were associate with W lesions; b 1-3 and W 1-4 lesions were thus partly associated with different potential risk factors. The pre- and perinatal potential risk factors could only partly explain the variance in the frequency of B and W lesions, indicating that there are yet unidentified risk factors for intracranial ultrasonographic pathology.

Cerebral Hemorrhage↗
PubMed1997

X-ray angiography in stereotactic conditions: techniques and interest for interventional neuroradiology.

This paper reports work in progress on X-ray angiography acquired under stereotactic conditions. The objective is to be able to match multimodality images (typically MRI and X-ray) without a stereotactic frame but with stereotactic precision. We have identified potential problems and have studied them in detail. We conclude that, although the overall application is feasible, much work remains to be done on the estimation of the X-ray system conic projection and on automatic matching based on vascular structures.

Angiography, Digital Subtraction↗
PubMed1996

Disorders of the cerebral white matter in children. The spectrum of lesions.

The use of magnetic resonance imaging (MRI) has resulted in the detection of an increasing number of children with an apparently leukodystrophic white matter. Laboratory tests and the clinical presentation, however, often do not correspond to any known entity and the course is sometimes not progressively deteriorating. Such children with white-matter changes and no known diagnosis were the subject of this Swedish multicentre study, in which MRI findings and clinical data from 100 children considered to have white-matter abnormalities were assessed during the period 1992-1995. At re-evaluation of MR images by an established "white-matter group" of neuroradiologists, paediatric neurologists, neurologists and neurochemists, the MRI signal of the white matter was considered normal in eleven children and eleven had mainly a grey matter affection. Of the remaining 78 children with white matter abnormalities, a diagnosis was found in 32, but in 46 children no diagnosis could be established. A progressive downhill course characterised 17, probably representing hitherto undefined types of leukodystrophies. Five children had a relapsing-remitting course, and in 11 it was difficult to establish whether the course was progressive or stationary. The disease was non-progressive in 13. This group of non-leukodystrophic white-matter changes obviously represents maldevelopments of myelin formation, thus dys- or hypomyelination rather than demyelination.

Adolescent↗
PubMed1996

Non-progressive ataxia: origins, brain pathology and impairments in 78 swedish children.

This population-based study refers to 78 Swedish children with non-progressive ataxia from a total population of 3.1 million inhabitants. Inclusion criteria were ataxic gait without any signs of spasticity, dyssynergia, dysmetria and intention tremor. CT and/or MRI studies were available from 70 patients (90%). Infratentorial pathology was revealed in 27%, and findings were considered normal in 61%. If CT was normal, of recent date and of good quality, MRI did not add any new information. In half of the cases with pathological CT, however, MRI provided new information. The origin was considered prenatal in 45% (familial in 17%), perinatal in 4% and unclassifiable in 51%. 60% were mentally retarded; in the rest, cognitive development was near normal (18%) or normal (22%). Speech development was delayed in 88%, and 58% had visual dysfunction.

Adolescent↗
PubMed1996

Visual impairment in preterm children with periventricular leukomalacia--visual, cognitive and neuropaediatric characteristics related to cerebral imaging.

Thirteen preterm children, aged 4 to 14 years, with visual impairment due to periventricular leukomalacia (PVL) were evaluated for visual function, intellectual level, cognitive profile and motor function. Their visual impairment was characterized by low acuity, crowding, visual field defects and ocular motility disturbances. Their cognitive profile was uneven, often with considerably higher scores on verbal than on visual-spatial tasks. Nine children had normal intelligence, three had mild mental retardation and one had severe mental retardation. In all the children, visual impairment was complicated by visual perceptual difficulties, accounting for their greater visual handicap than would be expected from their visual acuities and strabismus alone. Though CT or MRI revealed bilateral PVL in all the children, six had no motor impairment consistent with cerebral palsy, which is an unexpected finding.

Adolescent↗
PubMed1995

Early [18F]FDG positron emission tomography in infants with hypoxic-ischaemic encephalopathy shows hypermetabolism during the postasphyctic period.

Six full-term infants suffering from perinatal asphyxia and with moderate or severe hypoxic-ischaemic encephalopathy were investigated by positron emission tomography (PET). Regional cerebral metabolic rates of glucose (rCMRgl) were determined using [2-18F]2-fluoro-2-deoxy-D-glucose ([18F]FDG) PET scans at a median age of 2.5 days (range 2-5 days). Localized increases in rCMRgl were visually observed in five infants. In a subgroup of three infants, absolute values of rCMRgl in different brain regions were calculated. In all cases the results of the PET studies were in good agreement with those of the neuroradiological, neurophysiological and clinical investigations. Information indicating pathophysiological events could be extracted earlier with PET than with conventional morphological imaging techniques. We conclude that [18F]FDG-PET scans performed in critically ill, asphyxiated infants very soon after birth provide valuable information for the prediction about neurological outcome.

Asphyxia Neonatorum↗
PubMed1994

Conditions for treatment of cerebral arteriovenous malformation associated with ectasia of the vein of Galen in the newborn.

The survival rate and subsequent quality of life has improved significantly for neonates with cerebral arteriovenous malformation associated with ectasia of the vein of Galen, with recent advances in interventional neuroradiology. Transarterial endovascular occlusive techniques have emerged as the treatment of choice. However, this treatment is technically very demanding and good results are seen only in institutions with large experience in treating this rare type of congenital malformation. The conditions for granting the neonate access to this sophisticated type of treatment include appropriate clinical and neuroradiological evaluation at the highest possible level, combined with the establishment of early communication with a trained interventional neuroradiological team capable of this treatment. Not all neonates are suited to this form of treatment, but only rapid, careful and competent treatment and evaluation of the neonate can assure appropriate pre-procedural evaluation in order to give each patient, wherever born, a similar and optimized chance of survival without unnecessary sequelae.

Cerebral Veins↗
PubMed1994

Neonatal superficial cerebral arteriovenous malformations.

The purpose of this report is to determine the role of various imaging modalities, and the outcome of early intervention in neonates with high flow pial arteriovenous malformations (AVM). This report describes 4 neonates with pial AVM associated with congestive cardiac failure, and reviews previous reports. Among the 4 infants in our series, 3 underwent early surgical resection of the AVM, complete in 2 and partial in 1. One infant suffered hemorrhagic infarction postoperatively and has a mild deficit on clinical follow-up; the other 2 patients had no worsening of mild neurologic deficits after surgery, and subsequent development has been normal. The fourth infant had absent deep venous drainage and died from intracranial hemorrhage following transvenous embolization. A single vessel arteriogram in 1 infant led to underestimation of the lesion and unexpected findings at surgery. Complete angiographic study is important in planning treatment, as the vascular anatomy of the lesions may be complex. Cranial ultrasound is useful in early diagnosis, but may miss the superficial lesions. Untreated infants with pial AVM have a poor prognosis due to cardiac failure or progressive cerebral ischemia and neurologic regression. This series illustrates the benefits of complete angiographic investigation and early treatment.

Cerebral Angiography↗