Structural changes in the brain on cranial magnetic resonance imaging in severely malnourished children before and after treatment.

OBJECTIVE: The aim of this study was to examine the structural changes in brain on magnetic resonance imaging (MRI) in severely malnourished children before and after treatment. METHODS: This was a prospective study conducted at a Severe Malnutrition Treatment Unit (SMTU) at a tertiary care center. The study was carried out with 52 severely malnourished children 0 to 5 y of age admitted to the SMTU. The cases with neurologic diseases such as epilepsy, cerebral palsy, meningitis, tumor, or hydrocephalus; or history of perinatal asphyxia were excluded to enable us to detect central nervous system changes attributable to malnutrition only. MRI brain without contrast was performed on all 52 cases at admission and after 6 mo of treatment and were reported by an experienced radiologist. The common MRI findings in the study included cerebral atrophy, dilated ventricles, periventricular white matter changes, widened cortical sulci, enlarged basal cisterns, and widened interhemispheric fissure. Development assessment using the Denver Developmental Screening Test II was also performed to infer correlation with MRI findings. RESULTS: Of the 52 children who were severely malnourished, 10 (i.e., 19.2%) had abnormal MRI findings. Development assessment revealed that of the 10 abnormal MRI cases, 80% had delayed developmental milestones as well. These changes are reversible in most cases after nutritional rehabilitation. CONCLUSIONS: The present study revealed that malnutrition per se has a significant effect on the structure of the developing brain and also affects neurologic development. These changes are reversible after treatment so early stimulation and nutritional rehabilitation can help to prevent permanent neurologic derangements.

Hemiconvulsion-hemiplegia-epilepsy Syndrome: A Case Series.

Hemiconvulsion-hemiplegia-epilepsy (HHE) syndrome is an uncommon outcome of prolonged focal status epilepticus in childhood. We present four cases with age between 6 months and 3 years diagnosed with HHE syndrome. Two patients were lost to follow-up; other two cases had severe developmental delay and refractory epilepsy. An early diagnosis, a good seizure control, and a better understanding of the underlying mechanisms of HHE are needed to improve the outcome of this condition.