[Infectious diseases of the central nervous system in childhood].
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Brain Abscess↗
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Results for “Subdural Effusion”
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[Sub-dural filling in the pneumo-encephalogram of neonates and infants as a feature of traumatic arachnoid tears].
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Adolescent↗
Bacterial meningitis. A symposium. IV. Neurological aspects: their diagnosis and treatment.
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Anticonvulsants↗
[Make the diagnosis].
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Central Nervous System Diseases↗
[Liliequist membranotomy for patients with ruptured intracranial aneurysms (author's transl)].
In order to reconstruct the blocked CSF pathway, we attempted to excise the Liliequist membrane in 22 patients with subarachnoid hemorrhage resulted from ruptured intracranial aneurysms. After clipping the aneurysmal neck, the Liliequist membrane was reached through the space between the optic nerve and the internal carotid artery within the same operative field. As a result, the incidence of postoperative ventricular dilatation was remarkably reduced in comparison with control cases without Liliequist membranotomy. The necessity for the shunt operation for post-SAH hydrocephalus was also reduced. On the other hand, the incidence of postoperative subdural effusion increased in the group with Liliequist membranotomy. This suggests that the blockage of the arachnoid villi is probably the cause of disturbances in CSF absorption in some cases following subarachnoid hemorrhage. In such cases, the Liliequist membranotomy may be ineffective in restoring CSF circulation following subarachnoid hemorrhage.
Adult↗
Bacterial meningitis in infancy and childhood in Lusaka (One year prospective sturdy).
In approximately 10,000 admissions in a 12 months period, at University Teaching Hospital, Lusaka 85 cases of meningitis were recorded. The signs and symptoms in these patients do not greatly differ from other similar studies in Africa. The commonest organism isolated was pneumococcus. There was high mortality rate which was to a large extent due to parents not bringing their children to hospital early enough for medical treatment to be instituted. This is borne out by the fact that 50% of the children with meningitis died within the first 24 hours. The C.S.F. protein and peripheral white blood count may be of prognostic value. Spasticity, cranial nerve palsises hydrocephalus and subdural effusion were the commonest complications.
Cerebrospinal Fluid↗
[Intracranial pressure recording. Principles, technics, results and possibilities].
Methods for continuous ICP recording were further developed. Intraventricular pressure measurement requires puncture of the brain, and is susceptible to infection. For routine applications, therefore, preferential use is made of miniaturized pressure transducers which, without the need to open the dura, are simply implanted epidurally. In the absence of disorders of blood clotting, no complications, in particular no infections, were observed in more than 900 measurements. In the case of rapidly growing intracranial space-consuming processes, considerable intracranial pressure differences giving rise to intracranial mass shifts and even incarceration occur. These pressure gradients can also be measured and treated clinically. The pathological intracranial pressure curve shows typical wave dynamics with A, B, C and D waves, and pulsation changes. In intensive care, measurement permits rapid detection of complications, selective treatment and prognostic information, including the temporal definition of brain death. In neurological and neuropediatric diagnosis, ICP measurement differentiates between active hydrocephalus and cerebral atrophy/dystrophy, and here, as also in cystic cerebral changes, subdural effusions, etc., helps clarify the indication for surgery. In the case of "pseudo tumour cerebri", too, ICP measurement permits objectivation. In addition, it is also possible to determine directly the intracranial reserve space and the CSF dynamics (bolus/infusion test, pulse wave analysis).
Atrophy↗
Holoprosencephaly classified by computed tomography.
Five cases are presented to demonstrate the computed tomographic (CT) spectrum of holoprosencephaly. The classifications of alobar, semilobar, and lobar types A and B holoprosencephaly are each represented, with an additional case of semilobar holoprosencephaly complicated by a subdural effusion.
Brain↗
[Bacterial meningitis in children. Analysis of 181 cases].
Clinical records of 181 children, aged between one month and seven years, admitted in a four year period, from 1978 through 1982, with the diagnosis of bacterial meningitis are revised. Peak incidence occurred in the age group between six months and three years, and during the months of January to May. N. meningitidis (35%), pneumococcus (4.9%) and H. influenzae (2.7%) were the most frequently isolated bacteria. CSF culture was negative in 56% of the children. All of them had previously taken antibiotics. Complications were present in 6.4%, with highest incidence in the known-agent group, on the following order: septic shock, 11%, seizures, 6.6%, and subdural effusion, 2.2%. Permanent sequelae were present in 3.8%, being deafness predominant. Twelve (6.3%) out of the 181 died, and death was result of fulminant meningococcal sepsis with endotoxic shock in ten of these patients. Clinical and psychological followed-up of twenty-nine children with isolated causal agent, were compared with a control group, finding no statistically-significant difference.
Bacterial Infections↗
[Ultrasonic diagnosis in hydrocephalus].
Sonographic evaluation of the brain offers a noninvasive, safe and inexpensive method in diagnosis and follow-up of hydrocephalus associated with meningomyelocele. Cranial computed tomography should be reserved for special questions such as assessment of bony structures, subdural effusions or if fontanelles and sutures are already closed. Ultrasound of the neonatal head is completely harmless, repeated examinations can easily be performed and sedation of the infant is usually not necessary. The method of ultrasound sections in different directions is demonstrated and compared to axial CT sections. Value, effectiveness and diagnostic interpretation of the method are demonstrated in four cases: 1. Small lumbar meningomyelocele with mild hydrocephalus without enlargement on follow-up. 2. Giant spinal defect with kyphoskoliosis, marked hydrocephalus and associated ventricle abnormalities. 3. Sonographic follow-up after ventriculo-atrial shunting in a patient with congenital hydrocephalus. 4. Cerebrospinal fluid abdominal pseudocyst after ventriculo-peritoneal shunting. Thus ultrasound is an excellent method for following ventricular size and shunt-function in meningomyelocele-patients.
Abdomen↗
Bacterial meningitis. A follow-up study of 115 children.
The clinical and laboratory date on 115 pediatric patients with bacterial meningitis are presented. Sixty-one were less than 12 mo of age including 13 less than 1 mo of age. Thirty-nine children were treated prior to admission with antimicrobial agents which obscured accurate bacteriologic diagnosis in eight of them. Gram-negative enteric bacteria, mainly Escherichia coli, were recorded in 9 of 13 neonates. Hemophilus influenzae type B accounted for 56 (52%) of all isolated recorded in those greater than 2 mo of age, of which 35% were resistant to chloramphenicol. Seventy-eight patients (73%) recovered completely following 10 to 14 days of antimicrobial therapy. Fifteen patients died, most of whom were less than 1 yr of age, including five neonates. Major neurologic sequelae included subdural effusions, cerebral abscesses and recurrent convulsions. This study, which documents the infrequency of Streptococcus group B and H. influenzae as etiological agents of neonatal meningitis, indicates that treatment of this disease with ampicillin and an aminoglycoside is efficacious. Chloramphenicol may be the drug of choice in the postnatal period, since H. influenzae is partly resistant to ampicillin.
Aminoglycosides↗
Bacterial meningitis in infants and children in southern Taiwan: emphasis on Haemophilus influenzae type B infection.
During a four-year period from November 1988 to October 1992, 41 cases of bacterial meningitis with a positive cerebrospinal fluid (CSF) culture and/or CSF antigen test were collected at the National Cheng Kung University Hospital. The ages of the subjects ranged from 32 days to 13 years, with a median of seven months. The male to female ratio was 2.4:1. The most common causative agent was Haemophilus influenzae type b (Hib, 29.3%), followed by group B beta-hemolytic streptococci (GBS, 24.4%), Streptococcus pneumoniae (22.0%), Escherichia coli (4.9%), Neisseria meningitidis (4.9%), Salmonella species (4.9%), Klebsiella pneumoniae (4.9%), Pseudomonas aeruginosa (2.6%), and viridans streptococci (2.6%). The onset of GBS meningitis was always prior to four months of age. Of the 41 cases studied, 27 (65.9%) were aged from two months to five years; 12 (44.4%) of these had meningitis caused by Hib. Most of the cases (90.2%) had a fever as the first clinical manifestation. Ampicillin combined with a third-generation cephalosporin was effective against most of the causative pathogens. The most frequently encountered short-term sequelae were seizures (64.7%), subdural effusion (55.9%) and ventriculomegaly (44.1%). Observations on long-term sequelae are ongoing. While the case-fatality rate was as high as 33.3% in S. pneumoniae, and 25% in Hib-infected patients, the overall mortality rate was 17.1%. There is a need for greater emphasis on prevention through the use of available vaccines, including the newly introduced conjugate vaccines against Hib which are capable of eliciting immune responses in infants as young as two months.
Adolescent↗
[A case of Klippel-Trenaunay-Weber syndrome associated with intracranial multiple angiomas].
A case of Klippel-Trenaunay-Weber syndrome associated with multiple intracranial angiomas was reported. Intracranial angiomas with Klippel-Trenaunay-Weber syndrome is very rare. Only 4 cases are known to this day. A 24-year-old man fell at his workplace and suffered a head injury. He was admitted to our hospital. Neurological examination revealed no abnormality. However, physiological examination demonstrated hyperplasia and cutaneous hemangiomas of left lower leg, malformation of the left eyelid and clouding of the left cornea. CT showed left hemispheric atrophy and subdural effusion. MRI demonstrated multiple flow voids at the left cerebellar hemisphere and at pons. Cerebral angiogram demonstrated left cerebellar AVM and pontine angioma. Feeding arteries of the AVM were left superior cerebellar artery and left posterior inferior cerebellar artery. Those of the pontine angioma could not be identified. No spinal angiomas were revealed. While spinal angiomas associated with this syndrome are known, association of intracranial lesions are rare. Reported anomalies are angiomas, hemi-hypertrophy of skull and brain, carotid occlusion, megadolicoanomaly of the basilar artery, meningioma and glioma. Our case report with cerebral angiomas is the first one in Japan. We postulate that anomaly of our case originated at the Streeter's 2nd-3rd stage or that multiple anomalies occurred. We emphasize that intracranial, spinal or visceral angiomas, which can be fatal if it bleeds, should be routinely examined in Klippel-Trenaunay-Weber syndrome.
Adult↗
[Subdural exudate in bacterial meningitis in children].
A subdural exudate (SE) complicating bacterial meningitis in 28 children was diagnosed by the findings at diaphanoscopy, subdurography, thermography, CT, EEG, echo-EG, rheo-EG in the evidence of aggravating neurological symptoms. SE drainage was carried out in all the cases, in 20 patients it was bilateral. CNS age-specific anatomicophysiological features responsible for emergence of the exudate primarily in the anterior hemispheric compartments subject to consequent atrophy are considered when assessing mechanisms of the exudate development in infants.
Acute Disease↗
[Neonatal meningoventriculitis].
Clinical and autopsy data indicate that ventriculitis persists despite parenteral and intralumbar antibiotic therapy. In the present study, ventriculitis was documented as postmortem examination in nine newborns. These studies indicate that ventriculitis occurs commonly in neonates with meningitis, particularly when there is delayed sterilization of CSF culture, A clinician has to bear in mind the diagnosis of ventriculitis when: 1) There is poor clinical and/or laboratory response to the usual therapy. 2) He has a critically ill patient with lethargy, convulsions and bulging fontanels. 3) He culture an unusual organism. 4) He faces a suspected complication of meningitis: subdural effusion, ventriculitis or abscess. 5) A CSF from ventricular puncture with more than 150 WBC, glucose less than 50 mg. and protein more than 200 mg.
Anti-Bacterial Agents↗
[Traumatic subdural hygromas].
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Adolescent↗
99mTc-HMPAO brain single photon emission computerized tomography in mitochondrial encephalomyopathies.
BACKGROUND: Mitochondrial encephalomyopathies are heterogeneous diseases with common clinical features of muscle and/or the central nervous system. Although molecular and histological diagnoses have been established, imaging modalities for the functioning evaluation of these patients are still obscure. In this study, we tried to use 99mTc-HMPAO brain SPECT images to analyze various mitochondrial encephalomyopathies. METHODS: We examined 99mTc-HMPAO Brain SPECT studies of 15 patients with various types of mitochondrial encephalomyopathy (3 Leber's hereditary optic neuropathy (LHON), 4 Kearns-Sayre syndrome (KSS), 4 mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS), 3 myoclonic epilepsy and ragged-red fiber disease (MERRF), and 1 Leigh syndrome), diagnosed by molecular studies. RESULTS: The results of our studies show obviously decreased radiotracer accumulation in the parieto-temporal regions after stroke-like episodes in patients with MELAS and MERRF: Relatively diminished brain perfusion in patients with KSS is noted, probably secondary to severe encephalomyopathy or subdural effusion. However, there seems to be no significant correlation between the clinical manifestations and the imaging findings in LHON and Leigh. CONCLUSIONS: 99mTc-HMPAO Brain SPECT is useful in the diagnosing and assessment of the progress of MERRF, MELAS and KSS. However, its role in LHON and Leigh syndrome seems to be debatable.
Adult↗