Intracranial complications of midline nasal dermoid cysts.

BACKGROUND: Nasal dermoid cysts are common tumors in children. Due to anomalies in embryologic development of the nasal complex, sometimes an intracranial extension exists. When these cysts become infected they can lead to meningitis, brain abscess and death. METHODS: We report the case of a 1.5-year-old girl admitted to the paediatric intensive care unit after infection of a nasal dermoid cyst. RESULTS: The infant had a spiking fever and epileptic seizures. She was stabilized, intubated and a CT scan showed a subcutaneous mass with an adjacent zone of encephalitis and brain abscess formation. Neurosurgical interventions were necessary to lower intracranial pressure and control infectious spread. After a hospital stay of 69 days the child could be discharged. Due to her young age, irreversible brain damage is expected. CONCLUSION: Nasal midline dermoid cysts are considered benign swellings. When an intracranial extension exists, infection can lead to deleterious complications. It is important for health care practitioners to be aware of this imminent risk. Suspicion of a nasal midline dermoid cyst should prompt a careful clinical work-up with an ultrasound followed by CT or MRI imaging. The treatment is complete excision to avoid disastrous complications and recurrences.

Percutaneous closure of paravalvular leak after Cone repair for Ebstein's anomaly.

We report the use of an Amplatzer Vascular plug for percutaneous closure of a paravalvular leak after Cone repair in a 5-year-old boy with Ebstein's anomaly. A paravalvular leak of the tricuspid valve developed gradually after Cone repair-surgery. The combination of fluoroscopy, transesophageal and transthoracic imaging during general anesthesia was necessary for correct and safe positioning of the device by percutaneous approach. The results were promising.

Praxis and language are linked: evidence from co-lateralization in individuals with atypical language dominance.

We determined the neural correlates of word generation and tool use pantomiming in healthy subjects with typical (n=10) or atypical (n=10) language dominance to investigate similarities in response pattern and hemispheric specialization between language and praxis. All typical language dominant volunteers also revealed left hemisphere changes during tool use pantomiming in prefrontal, premotor, and posterior parietal regions. All atypical language dominant participants displayed right hemisphere engagement for tool use. Co-lateralization of the language and praxis networks was observed on group and individual level, regardless of the participant's handedness. Activation maps of the word generation and tool use pantomiming contrasts displayed overlap in five cortical regions: supplementary motor area, dorsal and ventral premotor cortex, dorsolateral prefrontal cortex, and posterior parietal cortex. Individual lateralization indices were calculated for each region and revealed significant positive group correlations between .51 and .95 with every other region within the paradigms. Positive cross-task correlations ranged between .72 (supplementary motor complex) and .97 (dorsal premotor cortex) and illustrate that the strength of hemispheric specialization of one task significantly predicts the side and degree of lateralization of the other task, suggesting a functional and topographic link between language and praxis. These findings support models that link gestures and speech to explain the evolution of human language. We argue that the existence of a common and co-lateralized network underlying the production of complex learned movement, whether it be speech or tool use, may represent the evolutionary remnant of a neural system out of which proto-sign and proto-speech co-evolved.

Cerebral lateralization of praxis in right- and left-handedness: same pattern, different strength.

We aimed to investigate the effect of hand effector and handedness on the cerebral lateralization of pantomiming learned movements. Fourteen right-handed and 14 left-handed volunteers performed unimanual and bimanual tool-use pantomimes with their dominant or nondominant hand during fMRI. A left hemispheric lateralization was observed in the right- and left-handed group regardless of which hand(s) performed the task. Asymmetry was most marked in the dorsolateral prefrontal cortex (DLPFC), premotor cortex (PMC), and superior and inferior parietal lobules (SPL and IPL). Unimanual pantomimes did not reveal any significant differences in asymmetric cerebral activation patterns between left- and right-handers. Bimanual pantomimes showed increased left premotor and posterior parietal activation in left- and right-handers. Lateralization indices (LI) of the 10% most active voxels in DLPFC, PMC, SPL, and IPL were calculated for each individual in a contrast that compared all tool versus all control conditions. Left-handers showed a significantly reduced overall LI compared with right-handers. This was mainly due to diminished asymmetry in the IPL and SPL. We conclude that the recollection and pantomiming of learned gestures recruits a similar left lateralized activation pattern in right and left-handed individuals. Handedness only influences the strength (not the side) of the lateralization, with left-handers showing a reduced degree of asymmetry that is most readily observed over the posterior parietal region. Together with similar findings in language and visual processing, these results point to a lesser hemispheric specialization in left-handers that may be considered in the cost/benefit assessment to explain the disproportionate handedness polymorphism in humans.