Cranial nerve palsies in childhood.

We review ocular motor cranial nerve palsies in childhood and highlight many of the features that differentiate these from their occurrence in adulthood. The clinical characteristics of cranial nerve palsies in childhood are affected by the child's impressive ability to repair and regenerate after injury. Thus, aberrant regeneration is very common after congenital III palsy; Duane syndrome, the result of early repair after congenital VI palsy, is invariably associated with retraction of the globe in adduction related to the innervation of the lateral rectus by the III nerve causing co-contraction in adduction. Clinical features that may be of concern in adulthood may not be relevant in childhood; whereas the presence of mydriasis in III palsy suggests a compressive aetiology in adults, this is not the case in children. However, the frequency of associated CNS abnormalities in III palsy and the risk of tumour in VI palsy can be indications for early neuroimaging depending on presenting features elicited through a careful history and clinical examination. The latter should include the neighbouring cranial nerves. We discuss the impact of our evolving knowledge of congenital cranial dysinnervation syndromes on this field.

Apparent diffusion coefficient scalars correlate with near-infrared spectroscopy markers of cerebrovascular autoregulation in neonates cooled for perinatal hypoxic-ischemic injury.

BACKGROUND AND PURPOSE: Neurologic morbidity remains high in neonates with perinatal hypoxic-ischemic injury despite therapeutic hypothermia. DTI provides qualitative and quantitative information about the microstructure of the brain, and a near-infrared spectroscopy index can assess cerebrovascular autoregulation. We hypothesized that lower ADC values would correlate with worse autoregulatory function. MATERIALS AND METHODS: Thirty-one neonates with hypoxic-ischemic injury were enrolled. ADC scalars were measured in 27 neonates (age range, 4-15 days) in the anterior and posterior centrum semiovale, basal ganglia, thalamus, posterior limb of the internal capsule, pons, and middle cerebellar peduncle on MRI obtained after completion of therapeutic hypothermia. The blood pressure range of each neonate with the most robust autoregulation was identified by using a near-infrared spectroscopy index. Autoregulatory function was measured by blood pressure deviation below the range with optimal autoregulation. RESULTS: In neonates who had MRI on day of life ≥10, lower ADC scalars in the posterior centrum semiovale (r = -0.87, P = .003, n = 9) and the posterior limb of the internal capsule (r = -0.68, P = .04, n = 9) correlated with blood pressure deviation below the range with optimal autoregulation during hypothermia. Lower ADC scalars in the basal ganglia correlated with worse autoregulation during rewarming (r = -0.71, P = .05, n = 8). CONCLUSIONS: Blood pressure deviation from the optimal autoregulatory range may be an early biomarker of injury in the posterior centrum semiovale, posterior limb of the internal capsule, and basal ganglia. Optimizing blood pressure to support autoregulation may decrease the risk of brain injury in cooled neonates with hypoxic-ischemic injury.

Variability of resistive indices in the anterior cerebral artery during fontanel compression in preterm and term neonates measured by transcranial duplex sonography.

OBJECTIVE: To determine the normal range of resistive index (RI) variability in clinically/neurologically unremarkable preterm and term infants and to compare the hemodynamic response to transient elevation of intracranial pressure. STUDY DESIGN: We measured RIs at baseline and following brief fontanel compression, assessing for differences in mean baseline and compression values and percent change. RESULT: One hundred and twenty-nine subjects were included in the study. Mean baseline RI and normal range were 0.7 in preterm (0.54 to 0.86) and 0.66 in term infants (0.52 to 0.8; P=0.001). Mean RI during compression was 0.71 in preterm and 0.68 in term infants (P=0.015). Mean percent change between baseline and compression was 5.86% in preterm and 7.45% in term infants (P=0.092). CONCLUSION: No difference in the hemodynamic response to transient elevation of intracranial pressure between different gestational groups, suggesting no significant differences in autoregulatory response.

Difficulties facing first-year medical students at Umm Alqura University in Saudi Arabia.

This study investigated medical students' study habits and perceptions of learning difficulties during their first year of study. A specially-designed questionnaire was answered by 165 second-year medical and medical science students at Umm Alqura University in Saudi Arabia. Out of the 7 difficulties listed in the questionnaire, students ranked peer competition first, followed by poor English language skills. Male students ranked peer competition as the top difficulty whereas females ranked it fourth. A majority of students were dissatisfied with the passive, lecture-based method of teaching and wanted the English language curriculum to be improved by more emphasis on conversation skills. Early introduction of the concept of active learning and effective studying habits is needed.

Difficulties facing first-year medical students at Umm Alqura University in Saudi Arabia

This study investigated medical students study habits and perceptions of learning difficulties during their first year of study. A specially-designed questionnaire was answered by 165 second-year medical and medical science students at Umm Alqura University in Saudi Arabia. Out of the 7 difficulties listed in the questionnaire, students ranked peer competition first, followed by poor English language skills. Male students ranked peer competition as the top difficulty whereas females ranked it fourth. A majority of students were dissatisfied with the passive, lecture-based method of teaching and wanted the English language curriculum to be improved by more emphasis on conversation skills. Early introduction of the concept of active learning and effective studying habits is needed