Sedation and general anesthesia for magnetic resonance imaging examination in children

The object of this study was to assess the efficacy and safety of this sedation protocol and to emphasize that pediatric patients need MRI suite with facilities to provide general anesthesia. Nine hundred and twenty five patients underwent resonance magnetic imaging. Oral sedation was to be given to children aged 5 years and below. Oral sedation consisted of choral hydrate 90mg/kg orally. All magnetic resonance imaging request for children who failed oral sedation as well as those referred for general anesthesia were reviewed by a consultant anesthetist who then allocated patients to undergo a procedure with either general anesthesia or intravenous sedation. Intravenous sedation consisted of either propofol 0.5mg/kg bolus followed by an infusion or midazolam 0.2-0.5mg/kg. General anesthesia was given using sevoflurane, intravenous propofol induction. Five hundred and fifteen patients [57.15%] scans were done without sedation. Whereas 46 scans were performed during the consultant anesthetist supervised sessions. Oral sedation failed in 25 out of 364 patients [6.9%]. Eighty seven per cent of children aged 5 years and below needed sedation compared with 4.5% of those aged over 10 years. This study concluded the use of a structured sedation protocol for MRI scanning, as it is effective and safe

Childhood primary angiitis of the central nervous system

To analyze the clinical course and magnetic resonance angiographic [MRA] abnormalities in children with primary angiitis of the central nervous system [cPACNS]. Cohort study. Neurosciences and Neuroradiology Department of the Children's Hospital, Lahore, from January 2009 to December 2010. The cohort comprised consecutive patients diagnosed as having cPACNS based on clinical findings and identification of arterial stenosis on magnetic resonance angiography [MRA] in the absence of an underlying condition that could cause these findings. The treatment protocol for ischaemic infarcts consisted of induction therapy with intravenous steroids pulses and intravenous immunoglobulin followed by maintenance therapy with azathioprine and low dose aspirin. When indicated, they were treated with anticoagulants at least for 4 weeks along with induction therapy. Patients were followed at a single centre and systemically assessed for clinical presentation, classification of disease as progressive or non-progressive, adverse effects of anticoagulants, aspirin, azathioprine and their hospital course. Sixty-eight children with medium-large vessel cPACNS [62% boys, 38% girls] with mean age of 8.5 +/- 3.5 years were enrolled in this study. Motor deficit [70%]; headache [64%] and fever [20%] were the commonest symptoms; whereas hemiparesis [60%]; seizures 55% [focal 35%, generalized 20%] and decreased conscious level [30%], were the commonest neurological findings. Neuroradiological findings were ischaemic strokes in 50 [73.5%], haemorrhagic strokes in 10 [14.7%] and ischaemic haemorrhagic lesions in 8 cases [11.8%]. Angiographically 51 [51/68, 75%] of the cohort had non-progressive [obliterative] and 17 [17/68, 25%] had evidence of progressive arteriopathy at the time of admission. No secondary haemorrhagic lesions were documented among infarcts strokes, which were treated with heparin and oral anticoagulants. Outcome was survival in 56 cases [81.5%] and death in 12 cases [18.5%]. All survivors were discharged on long-term oral aspirin; 15 of them were also commenced on azathioprine. Neurological findings among the 56 survivors were; normal 20%, minor disabilities in 25%, moderate disabilities in 20% and severe disabilities in 35%. The spectrum of cPACNS includes both progressive and non-progressive forms with significant morbidity and mortality. This treatment protocol of immunosuppressive therapy may improve long-term neurological outcome in children with medium-large vessel childhood primary angiitis of the CNS

Nephronophthisis: a variant

The case report describes a young boy with renal, retinal, hepatic and cerebellar involvement in a rare syndrome. He had polyuria, deranged renal functions and cystic lesions in kidneys, which led to the diagnosis of nephronophthisis [NPH]. Extra-renal involvement with night blindness, truncal ataxia, mental retardation and hepatosplenomegaly. Thus, every patient with NPH should be carefully examined for extra-renal involvement