Leptomeningeal dissemination of pilocytic astrocytoma in a 17-year-old boy.

Pilocytic astrocytoma with leptomeningeal dissemination is a rare phenomenon and can be associated with obstructive hydrocephalus and an unfavorable prognosis. Herein, we report a seventeen-year-old boy with a history of ventriculo-peritoneal shunt insertion due to severe hydrocephalus who presented with progressive headache and vomiting together with ocular and cerebellar signs and symptoms. Neuroimaging confirmed the presence of multiple intracranial masses in the cerebellum and thalamus. Intracranial dissemination of tumor to the the leptomeninges was seen during neuroendoscopy. Simultaneous biopsy and endoscopic third ventriculostomy were performed and the diagnosis of low-grade pilocytic astrocytoma with leptomeningeal dissemination was made by histological examination. The patient underwent chemotherapy in combination with radiotherapy to reduce the risk of reoccurrence of the primary tumor and was followed for one year.

Prognostic value of arterial blood gas disturbances for in-hospital mortality in pediatric patients with severe traumatic brain injury.

BACKGROUND: The aim of this study was to evaluate the changes of arterial blood gas as a secondary insult in children and young adults suffering from severe traumatic brain injury, and to assess the correlation, if any, with their in-hospital mortality. METHOD: In this cross-sectional study, the medical data of all children and adolescents with severe head trauma admitted to the Rasht Poursina Hospital were reviewed between April 2006 and September 2011. Data including age, gender, GCS upon admission, arrival and daily ABG values for the first 3 days, results of brain CT scan, as well as in-hospital mortality rate were collected. A logistic regression model was used to determine the association between acid-base disturbance and in-hospital mortality after adjustment for potential confounding factors. RESULT: Of the 108 patients, 75% were male and 25% were female; and 31.5% of them died in the hospital. Univariate analysis showed a significantly higher risk of mortality in patients who developed mixed metabolic acidosis plus respiratory acidosis on their admission day (OR = 3.94, p = 0.012). Multiple logistic regression analysis demonstrated that mixed metabolic acidosis plus respiratory acidosis (OR = 3.81, 95% CI = 1.18-12.27, p-value = 0.025) and GCS (OR = 0.457, 95 % CI = 0.31-0.65, p-value < 0.001) were two significant predictors of mortality, regardless of other confounding variables. CONCLUSION: The results of present study show that, in pediatric patients with severe head injuries, initial mixed metabolic acidosis plus respiratory acidosis and GCS are significant predictors of mortality, but other factors after adjustment for potential confounding factors had no prognostic effect.

Association of persistent hyperglycemia with outcome of severe traumatic brain injury in pediatric population.

PURPOSE: Hyperglycemia is a common secondary insult associated with an increased risk of mortality and poor outcome in traumatic brain injury (TBI), but the effect of hyperglycemia on outcomes of severe TBI in children and adolescents is less apparent. The aim of this study was to evaluate the association of hyperglycemia with mortality in pediatric patients with severe TBI. METHODS: In this cross-sectional study, data of all children and adolescents with severe TBI admitted to Poursina Hospital in Rasht, including age, gender, Glasgow Coma Scale (GCS) upon admission, mortality rate, hospital length of stay, and serial blood glucose during the first three consecutive ICU days following admission, were reviewed from April 2007 to May 2011. After univariate analysis and adjustment for related covariates, logistic regression model was established to determine the association between persistent hyperglycemia and outcome. RESULTS: One-hundred and twenty-two children were included with a median admission GCS of 6 (interquartile range (IQR) 5-7) and a median age of 13 years (IQR 7.75-17). Among them, 91 were boys (74.6%) and 31 were girls (26.6%); the overall mortality was 40.2% (n=49). Patients who died had a significantly greater blood glucose levels than survivors for the first 3 days of admission (P=0.003, P<0.001, P=0.001, respectively). Moreover, persistent hyperglycemia during the first 3 days of admission had an adjusted odds ratio of 11.11 for mortality (P<0.001). CONCLUSION: Early hyperglycemia is associated with poor outcome, and persistent hyperglycemia is a powerful and independent predictor of mortality in children and adolescents with severe TBI.

A randomized trial of propranolol versus sodium valproate for the prophylaxis of migraine in pediatric patients.

BACKGROUND: Migraine is the most common of the paroxysmal disorders to affect the brain in the pediatric population. Both propranolol and sodium valproate (valproic acid) have been advocated as prophylactic agents for childhood migraine. OBJECTIVE: To compare the efficacy and tolerability of propranolol and sodium valproate in the prevention of migraine in the pediatric population. METHODS: Sixty-three children (aged 5-15 years) with migraine without aura, as defined by the 2004 International Headache Society (IHS) criteria, were included in this prospective, double-blind clinical trial and were randomly assigned to two groups. Group A (n = 32 patients) received propranolol 3 mg/kg/day and group B (n = 31 patients) received sodium valproate 30 mg/kg/day, with at least 6 months of follow up. The propranolol dosage was adjusted to 2 mg/kg/day and the sodium valproate dosage to 15 mg/kg/day, after the first follow-up visit. Participants were evaluated by using a detailed questionnaire that asked about the features of headaches and general health characteristics. The study endpoints were successful treatment for a 4- to 6-month period; 3 months of a persistent unsuccessful or incomplete response to treatment; intolerable side effects; and/or patient non-adherence. All data were analyzed longitudinally by comparing baseline data with data from each follow-up. RESULTS: A total of 60 patients completed the full headache prophylaxis period. The baseline headache frequency was reduced by more than 50% in 83% of propranolol recipients and in 63% of sodium valproate recipients (statistically not significant); the overall reduction of baseline headache frequency per month was better in group A (p = 0.044). The mean headache frequency per month was reduced from 13.86 +/- 2.11 to 4.23 +/- 3.24 in group A, and from 13.23 +/- 2.43 to 5.83 +/- 4.04 in group B; the difference between the two groups was statistically significant (p < 0.01). The mean headache duration per week was decreased from 9.9 +/- 7.4 hours to 3.2 +/- 5.9 hours in group A, and from 9.1 +/- 6.9 hours to 3.7 +/- 5.0 hours in group B; although there was no statistically significant difference between propranolol and sodium valproate, headache duration was markedly improved with each drug (p < 0.002). Reduction of headache severity by at least one grade was seen in 64% of patients in group A and in 56% in group B, and complete cessation of headache attacks occurred in 14% of patients in group A and 10% in group B (not significant). Minor side effects appeared to be fairly well tolerated by patients in both groups, with no significant difference in side effects between the two groups. CONCLUSION: This prospective study supports the efficacy of propranolol and sodium valproate as prophylaxis for pediatric migraine without aura, based on IHS criteria. There were no significant differences between these two drugs in all evaluated parameters except for the mean headache frequency per month, which was lower with propranolol than with sodium valproate.

Association between iron deficiency anemia and first febrile convulsion: A case-control study.

OBJECTIVE: The relationship between iron deficiency anemia and febrile convulsions has been examined in several studies with conflicting results. The authors aimed to evaluate the relation, if any, of iron status with first febrile convulsion. METHODS: In this case-control study, the authors assessed 200 children with a diagnosis of first febrile convulsion, aged between 6 months and 5 years, during March 2005 to September 2006. The control group consisted of febrile children without convulsion; controls were matched to the cases by gender and age. RESULTS: The patients and controls were 22.86+/-12.86 and 21.91+/-13.58 months of mean age, respectively. The amount of RBC, serum iron, and plasma ferritin were significantly higher, and TIBC was significantly lower among the cases with first febrile convulsions than in the controls. The amount of Hb, Hct, MCV, MCH, and MCHC were also higher among cases than controls, but differences were not statistically significant. Iron deficiency anemia was less frequent among the cases with febrile convulsion, as compared to the controls, and its difference was not statistically significant; but there is not a protective effect of iron deficiency against development of febrile convulsion (odd ratio=1.175). The mean of temperature peak on admission was significantly higher in the febrile convulsion group (38.74+/-0.76 degrees C) compared with the controls (38.2+/-0.67 degrees C) (P<0.0001). CONCLUSIONS: The results of this study suggest that iron deficiency anemia was less frequent among the cases with febrile convulsion, as compared to the controls, and there is not a protective effect of iron deficiency against febrile convulsions.