ABSTRACT
Iron deficiency anaemia (IDA) has a peak prevalence of 4-8% in children aged 1-3 years of age and is known to be associated with developmental delay, lethargy, irritability and cognitive problems. Rarely, IDA has also been reported as a risk factor for stroke in otherwise healthy children. We report a series of four young children aged 14 months to 48 months with significant IDA. Three children had venous sinus thrombosis and one had arterial ischaemic stroke, without other risk factors. We discuss the potential underlying mechanisms and review the relevant literature. This report further consolidates the evidence for a strong association between IDA and childhood stroke and highlights an easily treatable (and preventable) risk factor.
Subject(s)
Anemia, Iron-Deficiency/complications , Stroke/etiology , Child, Preschool , Female , Humans , Infant , Intracranial Thrombosis/diagnosis , Intracranial Thrombosis/diagnostic imaging , Intracranial Thrombosis/etiology , Magnetic Resonance Angiography , Male , Stroke/diagnosis , Stroke/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
In 1996 we reported sequential magnetic resonance imaging study in an infant with merosin-deficient congenital muscular dystrophy with normal brain magnetic resonance imaging at 3 weeks and white matter changes by 6 months. We now report an infant with merosin-deficient congenital muscular dystrophy with a mild degree of white matter changes already present on brain magnetic resonance imaging at 5 days of age. The difference may be due to a difference in the T2 sequences used. The images in this present case were obtained with a fast spin echo sequence (echo time: 210 ms). The increased T2 weighted may be responsible for a better detection of the white matter changes at an early stage, when they can be missed on conventional, less weighting T2 sequences. These results suggest that, by using appropriate sequences, mild white matter changes may be detectable on brain magnetic resonance imaging in the first days of life in infants with merosin-deficient congenital muscular dystrophy.
Subject(s)
Cerebral Cortex/pathology , Laminin/deficiency , Muscular Dystrophies/pathology , Nerve Fibers, Myelinated/pathology , Age of Onset , Cerebral Cortex/physiopathology , Humans , Infant, Newborn , Laminin/genetics , Magnetic Resonance Imaging , Male , Muscular Dystrophies/physiopathologyABSTRACT
A new delivery system (Preci-Jet 50) which administers growth hormone through the skin using high pressure and without a needle was evaluated. This device was inconvenient and painful compared with a pen injection system. The conclusion is that the Preci-Jet is not the panacea for solving the problem of compliance with subcutaneous growth hormone injections.
Subject(s)
Drug Delivery Systems/instrumentation , Growth Hormone/administration & dosage , Administration, Cutaneous , Adolescent , Blister/etiology , Child , Child, Preschool , Cross-Over Studies , Drug Delivery Systems/adverse effects , Female , Growth Hormone/therapeutic use , Hemorrhage/etiology , Humans , MaleABSTRACT
Seventy-five children treated for craniopharyngioma between 1973 and 1994 were studied to demonstrate which pre- and intraoperative factors were indicative of a poor outcome as defined by a quantitative assessment of morbidity. This involved a retrospective review of 65 patients and a prospective study of 10 patients focused on clinical details and cranial imaging and a follow-up "study assessment" of 66 survivors performed over the last 2 years. As part of the assessment, 63 patients underwent magnetic resonance imaging with a three-dimensional volume acquisition sequence 1.5 to 19.2 years after initial surgery. Predictors of high morbidity included severe hydrocephalus, intraoperative adverse events, and young age ( < or = 5 years) at presentation. Predictors of increased hypothalamic morbidity included symptoms of hypothalamic disturbance already established at diagnosis, greater height ( > or = 3.5 cm) of the tumor in the midline, and attempts to remove adherent tumor from the region of the hypothalamus at operation. Large tumor size, young age, and severe hydrocephalus were predictors of tumor recurrence, whereas complete tumor resection (as determined by postoperative neuroimaging) and radiotherapy given electively after subtotal excision were less likely to be associated with recurrent disease. Based on these findings, the authors propose an individualized, more flexible treatment approach whereby surgical strategies may be modified to provide long-term tumor control with the lowest morbidity.
Subject(s)
Craniopharyngioma/surgery , Follow-Up Studies , Morbidity , Neurosurgery , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Prognosis , Risk FactorsABSTRACT
OBJECTIVE: To quantify the extent of hypothalamic damage after surgery for craniopharyngioma using magnetic resonance imaging (MRI) and to relate the findings to changes in body mass index (BMI). PATIENTS: Sixty-three survivors (36 males, 27 females) of childhood cramopharyngioma were treated surgically between 1973 and early 1994. METHODS: Cranial MRI was performed at a structured follow-up assessment 1.5-19.2 yr after the initial surgery. Hypothalamic damage was scored as 0 (no visible damage), 1 (intermediate), or 2 (severe). RESULTS: After surgery there was an increase in BMI standard deviation (SD) from diagnosis to study assessment in all but 7 patients. However, patients with MRI scores of 2 (n = 17) had a significantly greater increase in median BMI SD score at follow-up (+5.5 SD score), compared with +2.5 SD score and +1.1 SD score for patients with MRI scores of 1 or 0, respectively. Of the 17 cases with MRI scores of 2, 10 had a history of extreme weight loss or weight gain at presentation; preoperative neuroimaging demonstrated extensive hypothalamic infiltration by tumor in these cases. CONCLUSION: MRI gives sufficient anatomical definition to allow assessment of the extent of hypothalamic damage and, thereby, prediction of the patients most at risk for severe post-operative weight gain.
