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[Problems of diagnosis and treatment of otogenic abscesses of the brain in children].

In 1947-89, 49 children with otogenic abscesses of the brain and cerebellum were treated in the ENT department of the Kuban Medical Institute. During the first two decades the number of these patients was 34 and during the second two decades it was 15, i.e., the number decreased two-fold. In 25 cases, abscesses were located in the temporal lobe, in 14 cases--in the cerebellum, and in 10 cases, multiple abscesses of different localization were diagnosed. For diagnostic purposes electroencephalography, echoencephalography, angiography, pneumography and ventriculography were used although they were sometimes inefficient, especially in the cases of multiple abscesses. Computer tomography made it possible to determine not only the number but also specific localization of abscesses. The method was applied in 8 cases. After proper examination and treatment all the patients recovered. Out of 49 patients 28 recovered and 21 died. Out of 34 patients treated during 1947-67, 17 recovered and 17 died while out of 15 patients treated during 1968-1989, 11 recovered and 4 died. It can be concluded that a significant reduction of the number of cases with brain abscesses and a substantial increase of the success rate can be attributerd to the advanced methods of their detection (echoencephalography and computer tomography) and more efficient methods of therapy of middle ear suppuration.

Adolescent↗

PubMed1978

Gray scale ultrasonography in the evaluation of hydrocephalus and associated abnormalities in infants.

Improved gray scale ultrasonic equipment has made two-dimensional echoencephalography a useful diagnostic tool in the examination of the infant brain for fluid-containing structures such as dilated ventricles and cysts. Eighteen infants have been examined to exclude hydrocephalus and other abnormalities. Ten had significantly dilated lateral ventricles and three of these were shown to have associated intracerebral abnormalities. Another infant was demonstrated to have an arachnoid cyst or subdural hygroma with normal size ventricles. Ten of the 11 abnormalities were confirmed by some other neuroradiologic study.

Brain↗

PubMed1975

Experiences with the echo midliner in children.

Three hundred eighty-five children were examined with the Midliner echoencephalography unit. In examinations termed adequate, correct interpretations were made in 94.6% of healthy children versus 78% ill children. The incidence of adequate examinations increases with the child's age, but 58% of children with hydrocephalus had inadequate examinations, regardless of age. For the measurement of the infantile ventricle system the midliner is not appropriate.

Brain Diseases↗

PubMed1976

Echoencephalographs of 100 consecutive acute psychiatric admissions.

Echoencephalography (ECHO) on 100 consecutive acute short-term psychiatric admissions showed a high (12 per cent) incidence of abnormalities. Incidence of midline ECHO abnormalities was 2 per cent, comparable to similar studies. Ventricular enlargement accounted for the majority of ECHO abnormalities. This study also confirmed a previous report of a relationship between third ventricular size and response to treatment. Use of the ECHO as a screening test for these patients was safe and rapid. Correlative studies tended to confirm ECHO findings.

Adolescent↗

PubMed1982

Ultrasound detection of congenital arteriovenous aneurysm of the great cerebral vein of Galen.

Using combined echoencephalography and Doppler flow determination the diagnosis Arteriovenous aneurysm of the great cerebral vein of Galen could be made in two infants. Without vascular surgery one patient died, the other recovered completely. CT scanning confirmed the diagnosis. Invasive methods such as cerebral angiography were avoided. Case histories, neuropathological findings, ultrasound method and results are presented. Pathogenesis, clinical signs, treatment and prognosis are discussed. With the ultrasound method presented, the nature and location of the vascular anomaly were demonstrable, thus additional higher risk diagnostic methods could be avoided or planned more purposefully.

Autopsy↗

PubMed1990

Antenatal origin of neurologic damage in newborn infants. II. Multiple gestations.

Necrosis of the cerebral white matter may be identified in living infants with echoencephalography. Echoencephalographic studies were performed in 89 twins and 12 triplets at less than 36 weeks of gestation to determine the incidence and complications associated with antenatal necrosis of the cerebral white matter. Antenatal necrosis of the cerebral white matter was identified when brain atrophy or cavities in the white matter were present by day 3 of life. Fourteen infants (13.8%) were considered to have antenatal necrosis of the cerebral white matter. The incidence of antenatal necrosis of the cerebral white matter was higher in monochorionic than in dichorionic infants (30% vs 3.3%; p less than 0.001). Univariate analysis showed that antenatal necrosis of the cerebral white matter was significantly associated with polyhydramnios, intrauterine fetal death of the cotwin, hydrops, multiple placental vascular connections, and placental artery-to-artery, vein-to-vein, and artery-to-vein anastomosis. Logistic regression analysis showed that antenatal necrosis of the cerebral white matter was predicted by the presence of either artery-to-artery or vein-to-vein anastomosis and by intrauterine fetal death of a cotwin. Vein-to-vein anastomosis had the strongest association, because 89% of seven infants with vein-to-vein anastomosis demonstrated antenatal necrosis of the cerebral white matter (p = 0.003). Monochorionic multiple gestations frequently are complicated by antenatal necrosis of the cerebral white matter. Multiple vascular connections with vein-to-vein anastomosis appear as the most important associated factor for antenatal necrosis of the cerebral white matter in this population.

Analysis of Variance↗

PubMed1977

The aqueduct echo method applied to brain stem tumours.

Echoencephalography of the posterior fossa was performed in nine cases of brain stem lesion. In all instances a dorsal displacement of the cerebral aqueduct was disclosed by means of the aqueduct echo method. The quantitative displacement was expressed by the A:B ratio method and found to agree well with calculations from corresponding pneumoencephalography.

Brain Neoplasms↗

PubMed1992

Risk factors for early intraventricular hemorrhage in low birth weight infants.

Because earlier studies suggested that preterm infants with germinal matrix hemorrhage or intraventricular hemorrhage or both (GMH/IVH) present within the first 12 postnatal hours are at greatest risk for the development of high-grade hemorrhage and neurodevelopmental disability, we examined the risk factors for this insult among 229 neonates of 600 to 1250 gm birth weight in a multicenter study. All had echoencephalography (ECHO) within the first 11 hours and serially for the next 20 days; risk factor data were collected prospectively. Forty-three infants had GMH/IVH within the first 5 to 11 hours (mean age at ECHO 7.7 hours): 18 GMH and 21 grade II, 1 grade III, and 3 grade IV IVH. One hundred eighty-six infants did not have GMH/IVH at a mean age of 7.9 hours. Both groups of infants were similar in birth weight, gestational age, maternal risk factors, cord pH values, and surfactant therapy before ECHO. The group with early IVH had more vertex presentations than the group without early IVH (79% vs 55%, p = 0.043), less maternal tocolytic use (42% vs 60%, p = 0.029), and more vaginal deliveries (67% vs 44%, p = 0.005). In the first 21 days, severe IVH developed in 12 infants with early IVH and in 6 infants without early IVH (p < 0.001). There were more neonatal deaths (16% vs 6%, p = 0.035) and more deaths at any time during the primary hospitalization (23% vs 9%, p = 0.010) among the early IVH group than among the group without early IVH. Multivariate analysis indicated that the mode of delivery, fetal presentation, and birth weight were important and independent prognostic indicators of IVH.

Birth Weight↗

PubMed1981

[Ultrasonographic (B-scan) studies of the skull in childhood (author's transl)].

The technical and diagnostic possibilities of two-dimensional echoencephalography in newborns and infants are described. The technique is simple, easy to carry out and avoids irradiation. Real-time ultrasound gives a quick general view of the ventricular system while the details are best performed with a compound scan procedure, 310 investigations in 93 patients are analysed and presented. Sonography should now be the first investigation in infants with possible intracranial lesions. The investigation is particularly valuable in the post-operative control and follow-up of treated hydrocephalus. The most important limitation of the technique is the increasing sound deflection as the ossification of the skull proceeds.

Cerebrospinal Fluid Shunts↗

PubMed1977

Signs of sensory deprivation versus cerebral injury in post-hip-fracture patients.

Patients with a primary diagnosis of "postoperative hip fracture" often have a poor prognosis because of their inability to participate in rehabilitation programs. They tend to remain in a state of physical inactivity and sensory deprivation. The signs and symptoms of head injury associated with the hip fracture may be overlooked and attributed to sensory deprivation. Thirty-nine patients with fractured hip and 18 with multiple fractures were studied by means of electroencephalography, echoencephalography, and computer axial tomography. In 7, the findings indicated a cerebral lesion. At operation, a subdural hematoma was found in 5 patients and a tumor in 2; all but one made a dramatic recovery. Thus, after hip fracture, it is important that the patient be tested appropriately so that signs and symptoms of sensory deprivation may not be confused with those of an occult head injury. When indicated, surgical intervention may be a life-saving process.

Age Factors↗

PubMed1975

Non-invasive screening for surgical intracranial lesions.

The value and reliability of the combined results of skull radiographs, electroencephalography, echoencephalography, isotope angiography, and brain scanning in 147 patients suspected of having an intracranial space occupying lesions are analysed. The overall accuracy of the technique was 79%. No false negatives were found. The advantages of adopting the system proposed by the authors in everyday clinical work is discussed.

Arteriovenous Malformations↗

PubMed1975

The impact of computed tomography on neuroradiologic practice.

To assess the impact of computed tomography (CT) of the head on neuroradiologic and diagnostic practice, we analyzed its capabilities, performance, and usage in our practice during the past 18 months. The results were compared to similar data on other neurodiagnostic tests, i.e., electroencephalography (EEG), A-mode echoencephalography, cerebral angiography, cerebral pneumography, and nuclide brain scanning. All diagnostic techniques except EEG were used less often as the capabilities of CT became known to our clinicians.

Brain↗

PubMed1980

Cerebral ventricular size in children: a two-dimensional ultrasonic study.

The width of the bodies of both lateral ventricles was studied in 833 children using B-mode echography. It could be accurately measured in 99.9% of those under the age of 2, 94% of these 2 to 5, and 65% of those 6 to 12. The normal lateral ventricular ratio or LVR (width of body of LV/0.5 X internal skull diameter) was 0.24-0.36, but there was a borderline area and the upper part of this range (0.34-0.36) included some cases of early hydrocephalus. In 72% of the children with a head circumference greater than the 98th percentile, the LVR was 0.24-0.36. The greatest transverse diameter of the atrium of the normal lateral ventricle in children appears to be 10 mm, that of the normal third ventricle 5 mm. A water-delay system is described as being superior to a contact system for B-mode echoencephalography.

Cerebral Ventricles↗

PubMed1982

Ultrasonic evaluation of postventricular shunt dynamics in infants and young children.

Two-dimensional echoencephalography provides a noninvasive method of monitoring the response of hydrocephalus to shunting in young children and of detecting complications of shunting. In this study an average of 74% of the decrease of ventricular size seen within the first six postoperative days had occurred by the first postoperative day. An average of 49% of the eventual decrease in ventriculography size occurred within the first postoperative week. The most helpful scans in the early postoperative period were obtained on the first postoperative day and again in the latter half of the first week. A clear departure from the usual pattern may indicate children at particular risk for significant shunt-related problems. While shunt failure was the most common complication, others such as mantle collapse with subdural hygromas, subgaleal fluid collections, loculations secondary to fibrous adhesions, and arachnoid cysts can be clearly defined.

Cerebral Ventricles↗

PubMed1984

Evidence for late developmental deficit in very low birth weight infants surviving intraventricular hemorrhage.

88 very low birth weight preterm infants who had been evaluated with neonatal computed tomography scanning and/or echoencephalography were subsequently brought to follow-up. Serial neurodevelopmental testing at 6, 12, and 18 months corrected age demonstrated that even the lesser grades of germinal matrix and intraventricular hemorrhage may be associated with a relatively less favorable neurodevelopmental outcome.

Cerebral Hemorrhage↗

PubMed1985

Real time ultrasound diagnosis of hemorrhagic pathological conditions in the posterior fossa of preterm infants.

Real time echoencephalography (RTE) was used to diagnose and serially follow intracranial pathological conditions in the posterior fossa of infants with a gestational age of less than 34 weeks. The posterior fossa was studied in four planes (coronal, modified coronal, sagittal, and parasagittal) with a sector scanner equipped with a high frequency transducer that was placed on the fontanelles and the sutures. Hemorrhagic complications were easily differentiated from normal anatomy. RTE diagnosis was confirmed with computed tomographic scans (5 patients) and postmortem examination of the brain (18 infants). RTE is a precise and noninvasive technique to visualize hemorrhagic and other forms of abnormalities in the infratentorial compartment.

Cerebral Hemorrhage↗

PubMed2005

Prophylactic ibuprofen for the prevention of intraventricular hemorrhage among preterm infants: a multicenter, randomized study.

OBJECTIVE: Ibuprofen enhances cerebral blood flow autoregulation and was shown to protect neurologic functions after oxidative stresses in an animal model. For these reasons, we hypothesized that the prophylactic use of ibuprofen would reduce the occurrence of intraventricular hemorrhage (IVH) and its worsening toward grades 2 to 4 among preterm infants. To confirm this hypothesis, we planned the present prospective study. METHODS: This was a double-blind, randomized, controlled trial in which preterm infants with gestational ages of <28 weeks received ibuprofen or placebo within the first 6 hours of life. The infants were assigned randomly, at 7 neonatal care units, to receive ibuprofen (10 mg/kg, followed by 5 mg/kg after 24 and 48 hours) or placebo. Serial echoencephalography was performed 24 and 48 hours after the initial cerebral ultrasound study, on postnatal days 7, 15, and 30, and at 40 weeks' postconceptional age. Grade 1 IVH or no IVH was considered a successful outcome, whereas grade 2 to 4 IVH represented failure. The rates of ductal closure, side effects, and complications were recorded. RESULTS: We studied 155 infants. Grade 2 to 4 IVH developed for 16% of the ibuprofen-treated infants and 13% of the infants in the placebo group. The occurrence of patent ductus arteriosus was less frequent only on day 3 of life in the ibuprofen group. There were no significant differences with respect to other complications or adverse effects. CONCLUSIONS: Our study demonstrated that prophylactic ibuprofen is ineffective in preventing grade 2 to 4 IVH and that its use for this indication cannot be recommended.

Cerebral Hemorrhage↗

PubMed1975

Echoencephalographic A-scan study of the aqueduct and brain stem.

The author utilizes autopsy models and normal clinical subjects with and without pneumoencephalography to demonstrate the value of echoencephalography in delineating the position of the aqueduct of Sylvius. Echoes from the dorsum sellae, the anterior wall of the sella turcica, and the aqueduct proved consistently identifiable, while echoencephalographic examination of 25 normal subjects revealed in all instances well-defined aqueduct echoes. Thus the aqueduct echo method may be a diagnostic aid in determination of the anterior-posterior position of the brain stem.

Adolescent↗