Lack of valproic acid-associated weight gain in prepubertal children.

We evaluated whether prepubertal children treated with valproic acid did not gain excessive weight. This retrospective study of children with epilepsy, aged <12 years at enrollment, examined weight gain associated with valproic acid or carbamazepine monotherapy. There was no significant difference between the valproic acid (n = 31) and carbamazepine (n = 49) treated groups in average duration of therapy or mean age. Body mass index scores at the beginning and end of the study were used to evaluate weight gain, while compensating for gains in height. For valproic acid, the linear mixed model detected no gain in body mass index z-scores over time (T = 0.25, DF = 17.3, P = 0.80), though it detected a significant gain in body mass index z-scores for carbamazepine (T = 2.32, DF = 36.7, P = 0.02). Results for McNemar chi-square tests were similar. No significant proportion change occurred among children on valproic acid (chi(2) = 2.0, P = 0.15), whereas a significant increase in the proportion of overweight children occurred on carbamazepine (chi(2) = 4.5, P = 0.03). We detected no excessive weight gain for children on valproic acid, whereas this was demonstrated for a similar socioeconomic group on carbamazepine.

Spontaneous intracranial arterial dissection in the young: diagnosis by CT angiography.

BACKGROUND: Spontaneous carotid artery dissections have been rarely reported in children. Diagnosis has traditionally been confirmed by catheter arteriography. More recently diagnosis has been made by magnetic resonance imaging and magnetic resonance angiography; however the sensitivity of these techniques has yet to be determined. The authors are unaware of reports of carotid dissection confirmed by dynamic computed tomography (computerized tomographic arteriography) in the young. CASE PRESENTATION: We recently evaluated a fourteen year-old male following the development of transient neurologic symptoms. There was no antecedent illness or trauma. Dynamic computed tomography revealed an intracranial dissection involving the supraclinoid segment of the left internal carotid artery (confirmed by catheter arteriography). Studies for vasculitis, pro-thrombotic states, and defects of collagen were negative. CONCLUSION: Spontaneous carotid artery dissection is a potential cause of transient neurological symptoms and ischemic stroke in the pediatric population. Dynamic computed tomography appears to be a reliable diagnostic tool which can lead to early diagnosis.

Imaging of the brain, including diffusion-weighted imaging in methylmalonic acidemia.

Methylmalonic acidemia (MMA) is a multifactorial autosomal recessive inborn error of organic acid metabolism, often presenting with neurologic findings. We report the imaging findings in a case of a child with classic neurological and laboratory findings for MMA. Imaging studies demonstrated abnormalities within the basal ganglia, particularly the globi pallidi (GP). Diffusion-weighted abnormalities seen in patients with MMA during an acute episode of metabolic acidosis and at follow-up are discussed. The authors are aware of only one prior report of serial examinations demonstrating resolution of restricted diffusion in the GP. The biochemical and pathophysiologic basis of the imaging findings of MMA are explained.

Neurosarcoid presents differently in children than in adults.

BACKGROUND: Neurosarcoid is seldom recognized in children. In the absence of any large pediatric series, it has been assumed that the presenting signs and symptoms are identical in adults and children. OBJECTIVE: To test the hypothesis that childhood neurosarcoid differs in presenting signs and symptoms from neurosarcoid in adults. METHODS: We tabulated the initial neurologic signs and symptoms in all reported cases of childhood sarcoid with evidence of central nervous system involvement. These data then were compared with published studies of adult neurosarcoid. RESULTS: Twenty-nine cases (from the English, French, and German literature) had descriptions of presenting signs and symptoms. Ages were 3 months to 18 years; 48% (14 of 29) presented before 13 years. Seizures were the most common presenting symptom (38%, 11 of 29), and 73% of these children (8 of 11) were <13 years old at presentation. Twenty-one percent (6 of 29) had cranial nerve involvement at presentation, and all were >or=12 years old. Twenty-one percent (6 of 29) had hypothalamic dysfunction. Five children presented with headache, 4 with motor signs, and 3 with papilledema. Twenty-four percent (7 of 29) had mass lesions on imaging. CONCLUSIONS: Children with neurosarcoid present differently than do adults. Children are more likely to have seizures, less likely to have cranial nerve palsies, and perhaps more likely to have a space-occupying lesion. Our analysis of the cases available for review in the published literature suggests that children evolve to an adult pattern as they progress through adolescence.

"Congenital" Horner's syndrome and carotid dissection.

The authors describe a child presenting with Horner's syndrome after the repeated application of birthing forceps to the head and neck during vaginal delivery. Magnetic resonance imaging and angiography confirmed that the proximal right internal carotid artery (ICA) showed injury caused by dissection. Carotid duplex and transcranial ultrasonography provided supporting evidence of distal right ICA occlusion with the development of intracranial collaterals. The authors interpret these findings to indicate that the child suffered a traumatic dissection of the distal right ICA to mimic "congenital" Horner's syndrome (CHS). In a review of English medical literature published since 1972, the authors found 70 cases of CHS, none of which was attributed to carotid dissection. This case demonstrates that carotid dissection is an underreported cause of CHS.

Sydenham's chorea in the age of MRI: a case report and review.

A 9-year-old female with acute chorea was found to have multiple areas of abnormal signal on magnetic resonance imaging of the brain consistent with vasculitis. The child's serology and clinical course were indicative of Sydenham's chorea, and other causes of vasculopathy were excluded. Although magnetic resonance imaging findings similar to those observed in this patient have been rarely reported in Sydenham's chorea; their presence alone should not prompt a search for an alternative diagnosis.

Carbamazepine toxicity after influenza vaccination.

Accidental ingestion and drug interaction are known causes of carbamazepine toxicity. Less well recognized is the possibility that influenza vaccination may significantly increase carbamazepine blood levels. Our experience suggests that carbamazepine toxicity can result from influenza vaccination.

Calcium carbonate consumption during pregnancy: an unusual cause of neonatal hypocalcemia.

The occurrence of hypocalcemia in a term infant after the first few days of life is known to result from excessive dietary phosphate, hypomagnesemia, neonatal hypoparathyroidism, hypovitaminosis D, and maternal hyperparathyroidism. Less well recognized is the possibility that maternal ingestion of antacids may cause late neonatal hypocalcemia. Our observations suggest that taking large doses of calcium carbonate during pregnancy may be a potential cause of neonatal hypocalcemia.