Electroencephalographic correlation of clinical,radioisotopic brain scan,CT scan and postmortem diagnosis

Fifty three cases of different neurological disorders were studied in children and EEG correlation was done with clinical findings, RI brain scan, CT scan, carotid angiography, postmortem and operative findings. EEG was abnormal in 36/53 cases (67·92%), CT scan in 28/35 cases (80%), RI brain scan in 17/21 cases (80·95%), carotid angiography in 3/3 cases (100%) and postmortem and operative procedures were helpful in 10 cases. Out of 35 cases of CT scan, good EEG CT scan correlation was observed in 16 cases (45·71%) (including 3 cases of idiopathic epilepsy) and in 9 cases (25·71%), although the EEGs were abnormal, they did not correlate well with the abnormality revealed in CT scan. In the remaining 10 cases (28·57%), there was poor EEG CT scan correlation. Out of 21 cases of RI brain scan, good RI brain scan EEG correlation was observed in 17 cases (81%) and poor correlation in remaining 4 cases (19%). Carotid angiographic and EEG correlation in all 3 cases (100%); postmortem EEG correlation in 2/2 cases (100%) and operative procedures EEG correlation in 6/8 cases (75%). In 2 cases of infratentorial space occupying lesions EEG was normal. It is concluded that EEG is a fairly useful, noninvasive investigation in various neurological disorders in children.     

Infantile hemiplegia: clinical,electroencephalographic and computerised tomography study

Thirty-one patients with post-neonatally acquired infantile hemiplegia were assessed clinically, electroencephalographically and by CT scan. The mean age of onset of illness and when first seen in the neurology clinic were 20·2±20·1 months and 16·8±8·4 yr, respectively. Epilepsy was seen in 74 per cent of cases and mental retardation in 70 percent. Among patients with epilepsy, the EEG and CT scan were abnormal in 83 per cent and 87 per cent respectively. There was a positive correlation between an abnormal EEG and CT scan in 84 per cent of cases. The cause of hemiplegia could be clinically determined in only eight cases (26%). However, the CT scan showed abnormalities like cortical atrophy and porencephalic cyst, suggestive of a vascular or inflammatory aetiology in 68 per cent. The usefulness of CT in determining the aetiology in acquired infantile hemiplegia, especially when seen many years after the onset of illness is, emphasized.     

Cerebral infarction in infants and children: Clinical features, CT and EEG findings

In a retrospective study, medical records of twenty one infants and children who were diagnosed for cerebrovascular disease, were analysed. Patients with history of head injury, brain tumor and intracranial infections were excluded from the study. Age ranged between six weeks and 12 years. Fourteen were boys and 7 girls. Ten patients (47%) had known underlying risk factor. Hemiparesis and seizures were commonest presenting features as well as long term neurological sequelae in survivors. CT scan was abnormal in all patients whereas, EEG was abnormal in 90% with 76% lateralizing effect.     

Evaluation of neonates with esophageal atresia using chest CT scan

Recent literature stresses various factors that influence outcome in neonates with esophageal atresia (EA), including associated congenital anomalies, ventilator dependency, and gap length. Although the existing modalities can fairly accurately assess the first two factors, a comparable modality for assessing the interpouch gap in a natural unstretched position preoperatively is lacking. A technique of direct sagittal computed tomography (CT) scanning of the chest, initially employed by Tam et al. in 1987, was found to provide fairly accurate information on the level of origin of the fistula and the interpouch distance, with pouches in natural, unstretched positions, in two neonates with EA and distal tracheoesophageal fistula (TEF). However, no further studies were reported using this technique. We studied 10 neonates with EA and distal TEF, the most common variant, using this technique. The addition of axial cuts was done in the event of a short upper pouch or suboptimally-clear anatomical details in sagittal chest CT films. The preoperative information in our study subjects was found to corroborate well with operative findings except in the one patient with laryngotracheoesophageal cleft (LTEC). Prior information of a left bronchoesophageal fistula in two of the neonates with dextrocardia greatly helped us in saving operative time and difficulties and postoperative hassles. The chest CT scan proved to be a noninvasive and quick means for investigating neonates with the most common variant of EA. CT scanning could be extended for routine preoperative evaluation of neonates with EA to prepare for intraoperative problems, besides helping prognostication.     

Early diagnosis of herpes simplex encephalitis in childhood

In the initial phase of HSE the clinical symptomatology is more variable and insidious in babies and young children than in older children and adults. Combined clinical, neurophysiological and neuroradiological studies have been carried out in 12 children with proven HSE.Ten patients had the first EEGs taken during the acute phase of the illness and all showed large amplitude irregular slow activity, sharp waves and often spikes with variable distribution; in 7 cases periodic phenomena were recognisable. At a later stage localised low amplitude EEG activities were found in children with focal neurological symptoms. Areas of low attenuation were seen in the CT scans of the 7 children who had this investigation done at an early stage of their illness. Such low density regions persisted at follow-up and eventually cerebral atrophy with irregular features became obvious.Prompt EEG investigations combined with CT scans provide an early diagnostic clue for treatment. Follow-up EEG studies (including VEP) and CT scans may help assess the severity of residual cerebral damage in the survivors.     

The role of the CT scan in the management of blocked ventricular shunt

The problems involved in correcting proximal catheter block in shunted hydrocephalic patients are discussed and 32 patients undergoing proximal revision are presented. Methods of restoring drainage and preventing recurrent obstruction are described.     

Unilateral absence of thigh muscles confirmed by CT scan

A 5-month-old infant is presented with congenital absence of a group of muscles of the right thigh including the three adductors, gracilis, semimembranosus and semitendinosus. The diagnosis was suspected from the conventional radiographs and was confirmed by computerized tomography.     

Idiopathic arterial calcification in infancy,pathology, diagnosis and treatment modalities

Idiopathic Arterial Calcification Infancy is a well-documented rare entity that usually occurs within the first few months of life. Use of CT as a primary investigative modality in the diagnosis of IACI has not been frequently reported. In our case, using CT scan, arterial calcification in the chest and abdomen was demonstrated and the diagnosis was made easily. Causes of death, imaging and treatment modalities were reviewed from literature.     

Long-term neuropsychologic sequelae of childhood leukemia: correlation with CT brain scan abnormalities

Previous studies have failed to establish a direct relationship between behavioral disorders and organic pathology in long-term survivors of childhood acute lymphoblastic leukemia. We evaluated 23 long-term survivors who received central nervous system preventive therapy with cranial irradiation and intrathecal chemotherapy, using neuropsychologic tests and computed tomographic brain scans. The patients were in continuous first remission for 7 to 11 years, and none were receiving chemotherapy. On the basis of their CT scan findings, they were divided into three groups: 10 with normal CT findings, five with intracerebral calcifications, and eight with cortical atrophy. Neuropsychologic test results allowed prediction of CT scan findings with an 87% accuracy (P less than 0.001), indicating a strong correlation between the presence and type of CT scan abnormality and neuropsychologic functioning. Tests that measured verbal memory, attention, and functions correlated with frontal lobe integrity were most powerful in discriminating between groups.     

Preoperative diagnosis of benign hepatic hamartoma by correlation radioisotopic and angiographic studies

The case of a 12 year old girl with a hamartoma of the liver is reported. A preoperative liver scan showed accumulation of technetium-99m sulfur colloid in the tumor with isotopic and contrast arteriography demonstration of a hypervascular intrahepatic mass. Although these diagnostic findings are not pathognomonic of hamartoma, they are indicative of a benign lesion within the liver.     

CT and MRI in the diagnosis of tuberculosis

The advent of CT and MRI imaging in the last two decades has redefined the approach and analysis of various diseases including tuberculosis. Tuberculosis afflicts hollow and solid viscera. Genitourinary, hepatobiliary and adrenal tuberculosis is uncommon in children. CT and MRI have however shown several advantages over conventional radiology and other imaging modalities in early diagnosis and follow-up of tuberculosis in different parts of the body.     

CT and MRI in the diagnosis of tuberculosis

The advent of CT and MRI imaging in the last two decades has redefined the approach and analysis of various diseases including tuberculosis. Tuberculosis afflicts hollow and solid viscera. Genitourinary, Hepatobiliary and Adrenal tuberculosis is uncommon in children. CT and MRI have however shown several advantages over conventional radiology and other imaging modalities in early diagnosis and follow-up of tubeculosis in different parts of the body.     

Predictive value of electroencephalography and computed tomography in childhood non-traumatic coma

Objectives: To study value of electroencephalogram (EEG) and computed tomography (CT Scan) in predicting outcome of non-traumatic coma in children.Methods: 100 consecutive children, between 2 months to 12 years, with nontraumatic coma, (Glasgow Coma Scale score <-8). Demographic and clinical data was recorded at admission. EEG and CT scan were done within 24 hours of admission. Etiologic diagnosis was assigned on basis of clinical data and relevant laboratory investigations. The outcome was recorded as survived and died. Among survivors it was graded as no disability, or mild, moderate, or severe disability. Odds ratio and/or relative risk (RR) with 95% confidence interval (CI) were calculated.Results: EEG could be done in 60 patients (43 survived; 7 were normal, 8 had mild, 17 moderate and 11 severe disability) CT scan in 93 patients (60 survived; 11 were normal, 14 had mild, 21 moderate and 14 severe disability). A normal/borderline EEG was associated with good outcome (P = 0.001); 11 of 12 survived and of survivors 55% had no or mild disability. Electrocerebral silence on EEG was a predictor of death (OR = 44; 95% CI -1.5-7372; P =0.01). An abnormal EEG was associated with significant increase in risk of disability among survivors (RR=2.6, 95% CI= 1.2–5.4, P=0.03). Among CT abnormalities intracranial bleed suggested increased risk of death (RR = 2.1; 95% CI-0.8-5.3; P = 0.058), while, hydrocephalus was associated with better survival (RR = 0.7; 95% CI-0.5 to 0.96; P = 0.029). However, hydrocephalus when compared with other abnormal CT scan findings, was associated with higher risk of moderate and severe disability among survivors (P= 0.046)Conclusion: A normal CT scan and EEG, and some of the specific findings could be helpful in predicting outcome in children with non-traumatic coma. EEG and CT scan should be done at admission in all patients with non-traumatic coma if feasible     

CT and IVU in the diagnosis of Wilms' tumour A comparative study

CT whole-body scanning has been performed in 20 children in the evaluation of a suspected Wilms' tumour. All the patients had abnormal urographic fincings including a non-functioning kidney in 6 cases, severe urographic changes in ten cases and minor alterations suggesting a small spaceoccupying lesion in four patients. —A solid tumour was found in 13 of the patients, eight were renal tumours and five neuroblastomas. The rest of the children had benign lesions as the underlying cause of the abnormal clinical and radiological findings. —CT was superior to IVU in the differentiation between a solid tumour and benign lesions such as cysts and hydronephrosis; the examination gave important supplementary information of the size and extent of the solid nature of tumours and tended to be helpful in the preoperative differentiation between Wilms' tumour and neuroblastoma.     

新生儿脑死亡诊断标准探讨——新生儿脑死亡诊断评估1例并文献复习

摘要 目的 以儿童脑死亡标准为参考,通过诊断新生儿脑死亡病例分析,总结新生儿脑死亡的特点。方法 报道1例新生儿脑死亡的病例并复习汇总新生儿脑死亡文献。结果 患儿,男,胎龄39+4周,阴道分娩出生,出生体重3 370 g。生后无呼吸和心跳,生后Apgar评分1、5、10和15 min分别为1、2、2和2分。20 min后心跳恢复,叹气样呼吸。生后2 h转运至复旦大学附属儿科医院,仍呈昏迷状态,依赖机械通气,双侧瞳孔散大,对光反射和原始反射消失。血气分析提示严重代谢性酸中毒,间隔12 h 的2次扩容后血压稳定。可自主排尿,尿量正常。每天行神经功能评估始终处于昏迷中,无自主呼吸,肌张力和肌力严重低下,各种原始反射不能引出,双侧瞳孔散大,对光反射、咳嗽反射和角膜反射均消失。予振幅整合脑电图（aEEG）连续监测4 d电压均<2 μV,入院后5 d 脑干听觉诱发电位（BAER）、体感诱发电位、视觉诱发电位均不能引出。入院后6和12 d视频脑电图均提示<2 μV静息电压。入院后13和14 d行脑血流监测,提示大脑前、中、后动脉轻中度痉挛。入院后13 d头颅CT提示双侧大脑弥漫性低密度影,脑室扩大。自主呼吸激发试验进行了7 min,因严重心率减慢而终止。结合脑电图诊断脑死亡。以“brain death”AND “newborn” OR “neonatal” OR “neonate”在PubMed数据库共检索到28例新生儿脑死亡病例,结合本文的1例,29例新生儿脑死亡病例,早产儿8例（化脓性脑膜炎2例,严重脑室内出血5例,胎母输血1例）;脑死亡确诊日龄为入院后2~7 d,脑死亡的观察期2~9 d;足月儿21例（重度窒息11例,婴儿猝死综合征4例,严重感染3例,严重颅内出血2例,戒断综合征1例）;脑死亡确诊日龄为入院后1~6 d,脑死亡的观察期1~73 d。新生儿脑死亡临床诊断均达到以下标准：昏迷,对各种刺激无反应;脑干功能丧失,主要评估方法为瞳孔扩大,对光反射、角膜反射和眼脑反射消失;自主呼吸消失。24/29例行EEG评估,17例为静息电压（早产儿3例,足月儿14例）;7例首次监测为低电压; 28/29例进行了脑血流监测,脑血流消失25例,BAER检查3/29例,1例未引出;1/29例行aEEG监测提示低电压。结论 新生儿脑死亡诊断应更慎重,新生儿临床神经系统功能评估有其明显的发育特征,需要更长的观察期。aEEG在新生儿脑死亡评估中可能具有一定价值。     

Topographic mapping of brain potentials in the newborn infant: the establishment of normal values and utility in assessing infants with neurological injury

AIM: To demonstrate that quantitative EEG (qEEG) can be used as a non-invasive measure of brain injury by establishing normative data in term infants and contrasting it with other modalities of brain imaging. DESIGN: qEEG during quiet sleep was performed on 13 healthy full-term infants comprising a normal group and on 10 infants with neurological abnormalities identified on brain imaging studies (abnormal group) at 36-47 wk postconceptional age. Quantitative analysis was performed and topographic maps were produced for each patient. The EEG data from the normal group, after spectral analysis, yielded power data in the delta, theta, alpha, and beta frequency bands and coherence information, which then formed the normative database. qEEG from the infants in the abnormal group was then compared to this normative data. RESULTS: The normal group's mean absolute power in the delta, theta, alpha, and beta bands for all EEG leads combined were 278.48+/-83.83, 31.71+/-10.12, 29.20+/-2.04, and 35.76+/-11.35 uv2, respectively. The median frequency was 1.49+/-0.07, 5.45+/-3.46, 9.74+/-5.11, and 18.01+/-3.38 Hz, respectively. The qEEG was abnormal in all 10 study infants, while abnormalities were noted in the clinical EEG in 4 of 10, in the neuroultrasound in 5 of 10, in the CT in one of 6, and in the MRI in 2 of 2 tested. CONCLUSIONS: qEEG appears to be a useful non-invasive method for measuring brain injury as it correlates well with other modalities of brain imaging and, if corroborated by further study, may, in fact, be more sensitive in determining abnormalities in brain function.     

脑钠肽在儿童心血管疾病诊治中的研究进展

脑钠肽（BNP）是一种主要来源于心室的心脏内分泌激素,具有很强的利钠、利尿、扩张血管、抑制肾素–血管紧张素–醛固酮系统（RAAS）和交感神经系统活性作用。研究表明,心血管疾病患儿的血浆BNP及氨基末端脑钠肽原（NT-proBNP）水平升高,可以反映心室功能变化。该文就BNP/NT-proBNP的生物学特性、检测方法、正常值范围及其在儿童心血管疾病诊治中的研究进展作一综述。