ABSTRACT
An adolescent girl with systemic lupus erythematosus presented with selective brainstem dysfunction as the initial sign of central nervous system involvement. Although computed tomography was initially normal, magnetic resonance imaging demonstrated multiple, large brainstem lesions. Serial magnetic resonance imaging, which revealed resolution of most of these lesions, correlated with a good clinical outcome. We postulate that this magnetic resonance imaging pattern represents microinfarction with surrounding edema.
Subject(s)
Brain Stem/pathology , Lupus Erythematosus, Systemic/diagnosis , Adolescent , Female , Humans , Lupus Erythematosus, Systemic/diagnostic imaging , Magnetic Resonance Imaging/methods , Tomography, X-Ray ComputedABSTRACT
A combined retrospective and prospective study assessed the results of computed tomographic (CT) scans in infants and children without neurologic deficit who presented with initial onset of seizures. Of 101 pediatric patients, 81 had afebrile seizures and 20 had complicated febrile seizures (i.e., focal, multiple, or prolonged). Seven children (7%), 6 with afebrile and 1 with a febrile seizure, had CT abnormalities. Four patients (4%) required further diagnostic workup including angiography and/or surgery. Children with afebrile focal seizures were more likely to have an abnormality than those with afebrile generalized seizures without focal components (13% and 4.9%, respectively). This study demonstrated a lower percentage of overall CT abnormalities, yet a similar percentage of "therapeutically important" abnormalities, in neurologically normal children with new onset of seizures when compared to previous reports of children with chronic seizures. Although an abnormal CT was more likely to be associated with an abnormal electroencephalogram, a normal result did not eliminate the possibility of an abnormal CT.
Subject(s)
Brain/diagnostic imaging , Seizures, Febrile/diagnostic imaging , Seizures/diagnostic imaging , Tomography, X-Ray Computed , Adolescent , Child , Child, Preschool , Electroencephalography , Humans , Infant , Prospective Studies , Retrospective Studies , Seizures/physiopathology , Seizures, Febrile/physiopathologyABSTRACT
A patient developed a primitive neuroectodermal tumor (PNET) many years after therapeutic cerebral radiation and methotrexate treatment for leukemia. The differential radiologic and histologic diagnoses, as well as the possible co-oncogenic effects of radiation and methotrexate, are evaluated.
Subject(s)
Brain Neoplasms/etiology , Methotrexate/adverse effects , Neoplasms, Germ Cell and Embryonal/etiology , Neoplasms, Radiation-Induced/pathology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , Adolescent , Brain Neoplasms/chemically induced , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/pathology , Female , Humans , Injections, Intraventricular , Methotrexate/administration & dosage , Neoplasms, Germ Cell and Embryonal/chemically induced , Neoplasms, Germ Cell and Embryonal/diagnostic imaging , Neoplasms, Germ Cell and Embryonal/pathology , Neoplasms, Radiation-Induced/diagnostic imaging , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/radiotherapy , Tomography, X-Ray ComputedABSTRACT
An unusual presentation of a case of myeloblastoma (granulocystic sarcoma, chloroma) as demonstrated by computed tomography (CT) and selective angiography is reported. Our patient, who presented with acute hydrocephalus due to a large posterior fossa myeloblastoma, had no evidence of systemic disease in either peripheral blood smear, bone marrow aspiration, lumbar puncture or further metastatic workup. While no evidence for generalized disease was seen, systemic chemotherapy may help to prevent overt systemic leukemia.
