Behavior as a diagnostic aid in failure-to-thrive

The presence of a defined set of behaviors was examined in 67 hospitalized infants, 3-24 months old; 17 with organic failure-to-thrive (OFTT), 17 with nonorganic failure-to-thrive (NOFTT), and 33 with no signs of failure-to-thrive. The usefulness of assessing these behaviors to distinguish nonorganic from organic failure-to-thrive infants was evaluated. The frequency of behaviors per infant as well as the intensity of behaviors was greater for NOFTT. The order of decreasing frequency of behaviors was similar in both OFTT and NOFTT infants. Four of the 7 most prevalent behaviors occurred significantly more frequently in NOFTT than OFTT infants. The presence of these behaviors does not rule in NOFTT or rule out OFTT. However, when a number of the behaviors are present, particularly if they occur in high intensity, and when no organic disease is found, a diagnosis of NOFTT is suggested. Response to appropriate treatment remains the most reliable confirmation of the diagnosis.     

Differential diagnosis of cerebral seizures]

Several non-epileptic disorders may cause episodic and paroxysmal symptoms that resemble epilepsy and they must be considered in the differential diagnosis. Some of these disorders are discussed in the present review: vasovagal, vasomotor and cardiac syncopes, breath holding spells. Among the sleep disorders, parasomnias, nightmares and the benign neonatal sleep myoclonus are mentioned. Migraine with aura, alternating hemiplegia and benign vertigo of childhood are probably related disorders. Benign myoclonus of early infancy, paroxysmal choreoathetoses and pseudoepileptic or hysterical seizures are further non-epileptic attack disorders to be considered in the differential diagnosis.     

Complication rates of diagnostic cerebral arteriography in children

Background: Cerebral arteriography (CA) remains the gold standard in delineating both intra- and extracranial vascular anatomy. Most data relating to the safety of CA are drawn from studies of adult patients in whom the practicalities of the procedure, range of potential pathologies and comorbid factors are different from those in children. Objective: To evaluate the current local and neurological complication rates of paediatric CA in the setting of a tertiary level childrens hospital in the UK. Materials and methods: Data from patients who had undergone CA between January 1998 and July 2003 were reviewed. The medical, anaesthetic and nursing records, and angiography reports were reviewed for all identified patients. The following parameters were extracted and entered into a proforma: gender, age, ethnicity, diagnosis, cerebrovascular diagnosis, referral source, date of CA, number of vessels catheterized and local and neurological complications. Results: A total of 176 CA studies were undertaken in 150 patients (median age 7.3 years, range neonate to 19 years; 83 males, 67 females) during the 5.5-year study period. The majority of referrals originated from the neurology (58%) and neurosurgery services (27.8%). No neurological complications or deaths occurred. Local complications occurred in eight children (4.5%). Five children had a groin haematoma and two had bleeding at the puncture site. A single child had a reduced pedal pulse distal to the site of catheterization, but Doppler imaging was normal. Conclusions: CA has a continuing role in the evaluation of cerebrovascular pathologies in children. Neurological complications are rare and local complications are not uncommon (around 5%), but are not usually serious.     

视频脑电图对1岁内婴儿非惊厥性发作的诊断及鉴别诊断价值

目的：探讨1岁以内婴儿非惊厥性发作(non-conclusion seizures,NCS)的临床特征及视频脑电图(video electroencephalography,VEEG)对其的诊断及鉴别诊断价值。方法对30例 NCS 患儿在 VEEG 监测时先行20 min 清醒常规脑电图检查,然后继续监测2～4 h 记录醒-睡眠-觉醒 VEEG,将二者进行对比分析,同时1、2、3个月后分别随访患儿的 NCS 发作情况。结果常规脑电图监测期间3例(10.0%)出现发作事件,VEEG 监测23例(76.7%)出现发作事件,VEEG 监测儿童发作事件阳性率高于常规脑电图(P ﹤0.01)。30例患儿临床症状均为躯体性发作 NCS,无心因性发作,其中表现为非癫痫性强直发作者19例(63.3%),包括双眼凝视2例,咬牙或用力咧嘴2例,头后仰1例,伸颈或缩颈1例,耸肩2例,摇头晃头9例,全身用力或僵直、抖动、面色发红2例;表现为良性肌阵挛者7例(23.3%),良性非癫痫性婴儿痉挛者4例(13.3%);未见其他类型 NCS 发作。所有患儿均未进行抗癫痫药物治疗,15例患儿随访1个月内发作事件趋于消失,7例2个月后消失,1例患儿随访3个月消失,另有7例患儿3个月后发作次数明显减少,仅在高兴、生气或情绪激动时偶有发作。结论 VEEG 对1岁内婴儿 NCS 的诊断及鉴别诊断具有重要作用,同时对监测 NCS 病情进展也有重要价值。     

Diagnostic and therapeutic aspects of cerebral seizures caused by pseudohypoparathyroidism]

The knowledge of the pseudohypoparathyroidism is of great importance since the consequence of inadequate treatment may be serious. The most important features of the pseudohypoparathyroidism are the hypocalcemia and seizures. The following case concerns a patient with pseudohypoparathyroidism; the clinical symptoms and treatment of this disorder will be discussed.     

Neonatal seizures associated with cerebral lesions shown by magnetic resonance imaging

AIM—To determine the diagnostic potential of magnetic resonance imaging (MRI) in neonatal seizures; to elucidate the aetiology, timing, and prognosis of the cerebral lesions detected.METHODS—Thirty one term neonates with clinical seizures underwent ultrasonography between days 1-7 (mean 2.5 days) and a high field spin-echo MRI scan on days 1-30 (mean 8.1 days), both of which were repeated at 3 months of age. Routine investigation excluded, as far as possible, infection, haematological, and metabolic-toxic causes as causes of the neonatal seizures.RESULTS—Brain abnormality was demonstrated by MRI in 68% of infants and ultrasonographically in 10%. Diffuse brain lesions (present in 29%) were associated with high mortality (58%) and morbidity (42%), whatever the aetiology. In contrast to a better short term prognosis for neonates with focal lesions where no infants died, 33 % had a handicap, and the rest were normal at a mean follow up age of 21/2 years. Cerebral lesions were presumed to have antepartum origin in 43% of cases. Seizure aetiology was considered to be hypoxic-ischaemic in 35%, haemorrhagic in 26%, metabolic disturbances and cerebral dysgenesis in 16% and unknown in 23%.CONCLUSIONS—MRI detected a remarkably high incidence of brain lesions in neonatal seizures. Almost half of these were of prenatal origin and pathogenesis may essentially be attributed to hypoxic and/or haemodynamic causes.