Secondary Headaches in Children and Adolescents: What Not to Miss

Introduction

Headaches are a common occurrence in childhood and adolescence. Most children presenting with a chief complaint of headache have a self-limited infectious disorder or primary headache syndrome that should not require extensive workup.

Purpose of Review

Differentiating these conditions from other more serious causes of headache in children can sometimes be difficult. This article aims to provide information regarding “red flags” that should indicate a need for concern for disorders that require more urgent evaluation.

Recent Findings

Long-held beliefs about specific “red flags” that have been analyzed in recent years as to their validity and new criteria for the diagnosis of idiopathic intracranial hypertension have been elaborated based on study. These publications are reviewed in this article.

Summary

Knowledge of past and current literature on secondary headache in children, combined with thorough history taking and examination, should help determine when there is concern for a serious secondary cause for headache in children and adolescents and direct workup.

     

Apoptosis in alpha interferon (IFN-α) intratumoral chemotherapy for cystic craniopharyngiomas

Objectives

The aim of this study was to verify whether intracystic injections of alpha-Interferon (IFN-α) in cystic craniopharyngiomas were able to reduce the tumor by activating the Fas apoptotic pathway.

Materials and methods

Twenty-one patients with cystic craniopharyngiomas treated at the Pediatric Oncology Institute (IOP/GRAACC) of Federal University of São Paulo were submitted to intracystic chemotherapy with IFN-α. The tumor sizes of all patients were monitored and the apoptotic factor soluble FasL (sFasL) concentration was determined by ELISA (enzyme-linked immunosorbent assay) in tumor fluid samples from eight patients.

Results

There was a complete reduction in 11 patients, a partial response in seven, and a minor response in three patients. The concentration of sFasL was increased in all the eight patients examined concomitantly with the tumor size reduction.

Conclusions

Our data demonstrated that the IFN-α was able to induce Fas-mediated apoptosis together with a reduction in the tumor size; such an observation may suggest the importance to investigate still unexplored mechanisms to be exploited in craniopharyngioma therapy.

     

Pilocytic astrocytoma with anaplastic features presenting good long-term clinical course after surgery alone: a case report

Purpose

Pilocytic astrocytomas (PAs) are the most common brain tumor in children and typically have an excellent prognosis. However, some PAs show histologically anaplastic features. It is reported that PAs with anaplastic features often need the postoperative radiation and chemotherapy due to aggressiveness such as early local recurrence and dissemination. We describe an interesting case of primary anaplastic PA with good clinical course in the long-term.

Methods

A 10-year-old man presented with worsening headache and vomiting. Magnetic resonance imaging (MRI) showed a large cystic tumor with contrast-enhanced solid component in a right occipital lobe. Magnetic resonance spectroscopy (MRS) showed the decrease of N-acetylaspartate (NAA) and the increase of choline and lipids, which suggested the malignancy.

Results

The patient was operated with an occipital lobectomy. The tumor was incompletely resected due to the deep invasion to the inner wall of lateral ventricle. Pathological diagnosis was a pilocystic astrocytoma with anaplastic features. Although aggressive features were suspected from magnetic resonance spectroscopy and pathological findings, the remnant tumor showed no recurrence for 8 years without any postoperative treatments.

Conclusion

PAs could exhibit variable behavior, and careful managements including wait-and-scan should be considered, because adjuvant therapies may cause child’s growth disorder and malignant transformation.

     

Familien von anfallskranken Kindern

Background

Epilepsy has an impact on not only the affected child, but also the whole family, especially the parents.

Aim of the study

To give an overview of the psychosocial impact of a child’s epilepsy on his/her family.

Methods

This overview is based on a selection of primary studies, which were mainly identified by a PubMed search.

Results

Besides various worries, high support needs, and mental health problems on the part of the parents, the epilepsy of a child also leads to stress for their siblings and strains in the relationships within the family. Furthermore, there are several limitations both in everyday life and in the social activities of the affected families. The presence of additional behavioral or health problems in children has been found to be an important factor influencing the impact of epilepsy on families.

Conclusion

In a comprehensive treatment approach for children and adolescents with epilepsy, the disease-related burdens of the family should be taken into account and psychosocial support should be provided.

     

Link between overweight/obese in children and youngsters and occurrence of multiple sclerosis

Background/aims

The prevalence of overweight/obesity is a major problem in the world, and the number of MS cases is increasing. This literature study examines the relationship between overweight/obesity in children and adolescents and later occurrence of MS.

Method

This is a complete literature survey. The search database is primarily Pubmed using MeSH terms “multiple sclerosis”, “obesity”, and “overweight”, and text words not to restrict searches.

Results

All included studies show a link between being overweight/obese and the presence of MS among people below 20 years of age. The relation is especially true for young girls. The same relation in boys is not significant.

Conclusion

The literature survey convincingly revealed a link between young overweight/obese and occurrence of MS, in particular for girls. There is a need for more and larger studies to investigate the molecular mechanisms that link obesity and MS.

     

District and School Physical Education Policies: Implications for Physical Education and Recess Time

Background

The relationship between physical education (PE) policies and children’s PE and recess time is not well understood.

Purpose

The purpose of this study is to assess the association of district and school PE policies, the PE environment, and PE and recess time.

Methods

Key informants in 65 schools from 9 states completed instruments assessing district and school PE policies, the school PE environment, and time in PE and recess.

Results

Few significant associations were found between PE policies and PE or recess minutes; no policies were associated with both. A number of PE environmental variables were associated with both policies and time in PE and recess.

Conclusions

PE policies, their implementation, and PE environmental variables can have important implications for recess time. Some school PE environment measures designed to improve PE may result in PE time limitations. Deficiencies in PE and recess time are not likely to be effectively addressed through policy adoption alone.

     

Influence of previous treatments on repeat surgery for recurrent craniopharyngiomas in children

Purpose

Craniopharyngioma is a common pediatric brain tumor, with a high rate of recurrence after primary treatment. This retrospective study investigated the effect of various primary treatments on surgical strategies and outcomes for recurrent craniopharyngiomas.

Methods

The study population comprised 35 children (mean age 8.77 years, range 1–16 years) with recurrent craniopharyngioma re-operated from January 1990 to January 2009. The recurrent craniopharyngiomas were excised whenever possible. For analysis, the patients were divided into four groups according to the primary treatment: radical tumor resection (A), incomplete tumor resection (B), radiotherapy + incomplete tumor resection (C), and Ommaya reservoir placement + incomplete tumor resection (D).

Results

Group B had a significantly shorter recurrence-free interval than groups A, C, or D. Outcomes were significantly different among the four groups. The hypothalamic status scores of groups A (2.38 ± 0.27) and C (2.28 ± 0.42) were significantly higher than that of group B (1.64 ± 0.20). There were no statistical differences between any two other groups.

Conclusions

In children, the primary treatments for craniopharyngioma should be considered when choosing the surgical strategy for recurrence. Radiotherapy before repeated surgery can result in a worse functional outcome and hypothalamic-pituitary function.

     

Preoperative neurocognitive evaluation as a predictor of brain tumor grading in pediatric patients with supratentorial hemispheric tumors

Objective

The objective of the present study was to retrospectively evaluate the relationship between tumor grading and a selective evaluation of neurocognitive and behavioral functions in children with supratentorial hemispheric brain tumors.

Methods

Children admitted with a diagnosis of supratentorial hemispheric tumors involving the cerebral hemispheres or the thalamus at the Pediatric Neurosurgery Unit of the Catholic University of Rome between January 2008 and January 2014 were considered for the present study. Exclusion criteria were represented by age less than 2 years, severe neurological deficits, seizures, and a metastatic disease. A selective neurocognitive and behavioral workout was used for children aged less and more than 5 years.

Results

Global cognitive functions as well as selective neurocognitive and behavioral profiles were found to be significantly worse in children with low-grade tumors, compared with those affected by higher-grades histotypes. Frontal locations for cortical tumors and thalamic lesions were significantly related with worse results, with a clear contribution of dominant vs. nondominant hemisphere involvement and an age higher than 5 years.

Conclusions

Preoperative global and selective neurocognitive evaluation might contribute to the prediction of the tumor aggressiveness. Due to a longer clinical history, more benign tumors more frequently arrive to the diagnosis with a neurocognitive compromise in spite of an apparently mild presence of neurological symptoms and signs.

     

Effect of Bike Lane Infrastructure Improvements on Ridership in One New Orleans Neighborhood

Background

Incorporating cycling into daily life is one way to increase physical activity.

Purpose

This study examined the impact of building new bike lanes in New Orleans to determine whether more people were cycling on the street and with the flow of traffic after bike lanes were built.

Methods

Through direct observation of one intervention and two adjacent streets, observers counted cyclists riding on the street and sidewalk, with and against traffic, before and after installation of the lanes. Data were tallied separately for adults, children, males, females, and by race for each location.

Results

There was an increase in cyclists on all three streets after the installation of the bike lanes, with the largest increase on the street with the new lane. Additionally, the proportion of riders cycling with traffic increased after the lanes were striped.

Conclusions

Bike lanes can have a positive impact in creating a healthy neighborhood.

     

A thoracic spinal bone giant cell tumor in a skeletally immature girl. A case report and literature review

Purpose

Giant cell tumors (GCT) are benign primary bone tumors, locally aggressive, affecting in long bones in young adults during the third decade. It is rare to experience this lesion in skeletally immature patients. GCT are related to a risk of local recurrence and malignant transformation.

Method

We report a rare case of a giant cell tumor of the thoracic spine in a skeletally immature girl presenting with a painful right scoliosis.

Results

MRI, CT scan, and bone scintigraphy were discordant and the percutaneous biopsy non-contributive.

Conclusion

A marginal “en bloc” resection was performed and revealed the GCT. Based on a literature review, the diagnosis and the surgical management of this case are discussed.

     

Spinal cavernous extradural angiolipoma manifesting as a spontaneous spinal epidural hematoma in a child

Introduction

Angiolipomas are benign tumors usually manifested as subcutaneous nodules. Rarely they may form spinal extradural masses. These spinal cavernous angiolipomas have mostly been described in adults.

Diagnosis

To our knowledge, spinal cavernous angiolipomas have been reported in nine pediatric patients.

Clinical presentation

In this paper, we present a 1-year-old child presenting with a spontaneous spinal epidural hematoma from a spinal cavernous angiolipoma and highlight the importance of conducting a histopathological analysis of spontaneous hematomas in previously healthy children.

     

An Update on the Approach to the Imaging of Brain Tumors

Purpose of Review

Neuroimaging plays a critical role in diagnosis of brain tumors and in assessment of response to therapy. However, challenges remain, including accurately and reproducibly assessing response to therapy, defining endpoints for neuro-oncology trials, providing prognostic information, and differentiating progressive disease from post-therapeutic changes particularly in the setting of antiangiogenic and other novel therapies.

Recent Findings

Recent advances in the imaging of brain tumors include application of advanced MRI imaging techniques to assess tumor response to therapy and analysis of imaging features correlating to molecular markers, grade, and prognosis.

Summary

This review aims to summarize recent advances in imaging as applied to current diagnostic and therapeutic neuro-oncologic challenges.

     

Primary sporadic Burkitt lymphoma of the orbit,clinical characteristics,management, and outcomes: a case study

Background

Involvement of the orbit with Burkitt’s lymphoma is a very rare presentation of extra-nodal lymphoma.

Illustrative case

We report a case of a 2-year-old female presented an unusual location of sporadic Burkitt’s lymphoma arising in the orbital region. Diagnostic magnetic resonance imagining identified an oval-shaped mass on the lateral rectus of the right orbit that caused dislocation of eyeball, for which she underwent a biopsy from the periorbital swellings.The mass was histologically confirmed as Burkitt’s lymphoma, and postoperative aggressive chemotherapy was initiated.We describe clinical diagnosis, histological aspects, radiological features, and current management of this rapidly growing malignant tumor.

Conclusion

Because of the rapid progression of Burkitt lymphoma, and considering that it responds well to treatment, early recognition and appropriate management are important factors for survival and to preserve visual function.

     

The effects of long-term medication on growth in children and adolescents with ADHD: an observational study of a large cohort of real-life patients

Background

Children and adolescents with ADHD treated with central stimulants (CS) often have growth deficits, but the implications of such treatment for final height and stature remain unclear.

Methods

Weight and height were assessed multiple times in 410 children and adolescents during long-term treatment with CS, which lasted between 0.9 and 16.1 years. Weight and height measures were converted to z-scores based on age- and sex-adjusted population tables.

Results

CS treatment was associated with (1) a relative reduction in body weight and a temporary halt in growth, (2) a weight and height lag after 72 months compared with relative baseline values. No relation to early start of medication (<6 years), gender, comorbid ODD/CD or emotional disorders was observed.

Conclusions

Treatment with central stimulants for ADHD impacts growth in children and adolescents, and growth should be continuously monitored in patients on chronic treatment with these medications.

     

Endoscopic third ventriculostomy: the best option in the treatment of persistent hydrocephalus after posterior cranial fossa tumour removal?

Background

Ten to 40% of children operated on for a posterior fossa tumour require a further surgical procedure for the management of a persisting active ventricular dilation. The management of this kind of hydrocephalus is still controversial.

Objective

To prospectively evaluate the effectiveness of post-operative endoscopic third ventriculostomy (ETV) in the management of persistent active hydrocephalus in a series of children operated on for a posterior cranial fossa tumour.

Methods

The management protocol consisted of: (1) placement of a peri-operative antibiotic impregnated external ventricular catheter (Bactiseal®) and tumour removal, (2) post-operative intracranial pressure (ICP) monitoring through the external ventricular drainage, (3) ETV in case of persistent ventricular dilation and persistently abnormal high ICP values and (4) ventriculoperitoneal shunt implantation in case of ETV failure.

Results

Thirty on a total of 104 children (28.8%) operated on between January 2001 and February 2007 at our institution needed a further surgical treatment for the persistence of the hydrocephalus after the removal of their posterior cranial fossa tumour. They were sub-divided in two groups according to the early (group 1—21 patients) or later (group 2—nine patients) definition of the persistence of an active ventricular dilation based on clinical, radiological and ICP monitoring data. ETV was successful in 90.0% of the patients in the present series (27/30 patients), without statistically significant differences among the two groups considered.

Conclusions

Post-operative ETV should be considered the best option to treat persistent hydrocephalus after the removal of posterior fossa tumours.

     

Contour Detection in Colour Images Using a Neurophysiologically Inspired Model

Background

The predictive coding/biased competition (PC/BC) model of V1 has previously been applied to locate boundaries defined by local discontinuities in intensity within an image.

Objective

Here PC/BC is extended to perform contour detection for colour images. Methods The proposed extensions are inspired by neurophysiological data from single neurons in macaque primary visual cortex (V1).

Results

The behaviour of this extended model is consistent with the neurophysiological experimental results. Furthermore, when compared to methods used for contour detection in computer vision, the colour PC/BC model of V1 slightly outperforms some recently proposed algorithms which use more cues and/or require a complicated training procedure.

Conclusions

The colour PC/BC model of V1 can successfully simulate the responses properties of orientation-selective double-opponent neuron in macaque V1 and has practical applications for contour detection in natural images.

     

Facilitating triple rhomboid flaps for meningomyelocele defect closure using a honeycomb structure as a template

Purpose

Various reconstruction options are available for the soft-tissue coverage of meningomyelocele defects. For small defects, primary closure or local single flaps may be sufficient, while large defects require more complex reconstructive techniques. This study suggests an easy way for surgeons to close large meningomyelocele defects using triple rhomboid flaps.

Methods

The hexagonal structure of a honeycomb was considered when planning for the coverage of large meningomyelocele defects. The intact skin around the defect was imagined as multiple hexagons, which allowed us to plan triple rhomboid flaps correctly and more easily. This technique was used in seven patients with defects ranging from 7?×?5 to 12?×?8 cm in size.

Results

No major postoperative complications were seen. Minimal dehiscence was observed in two patients and healed secondarily.

Conclusions

The honeycomb modification for planning triple rhomboid flaps is an easy, practical, and memorable approach for surgeons reconstructing large meningomyelocele defects.

     

School Sport Participation Under Two School Sport Policies: Comparisons by Race/Ethnicity,Gender, and Socioeconomic Status

Background

School-based extracurricular sport remains an effective strategy to increase physical activity. However, school sport is often limited to a small number of elite athletes. Few schools provide more inclusive sport programs that offer a wider array of activities regardless of ability.

Purpose

The aim of this study was to examine school sport participation in middle schools (ages 11–14) with contrasting school sport delivery strategies (intramural vs. interscholastic).

Methods

Data were obtained through an online survey administered to students at four public middle schools (grades 6–8) in a southeastern US city (n?=?2,582).

Results

More students participated in school sports at intramural schools. Boys were more likely to participate in after-school sports at intramural schools. Low-income and Black children, two groups at greater risk of physical inactivity and other negative outcomes, had greater participation in intramural programs.

Conclusions

After-school intramural sports in middle school is a promising strategy for increasing sport participation.