Influence of intrauterine and extrauterine growth on neurodevelopmental outcome of monozygotic twins.

There have been indications that intrauterine and early extrauterine growth can influence childhood mental and motor function. The objective of the present study was to evaluate the influence of intrauterine growth restriction and early extrauterine head growth on the neurodevelopmental outcome of monozygotic twins. Thirty-six monozygous twin pairs were evaluated at the corrected age of 12 to 42 months. Intrauterine growth restriction was quantified using the fetal growth ratio. The effects of birth weight ratio, head circumference at birth and current head circumference on mental and motor outcomes were estimated using mixed-effect linear regression models. Separate estimates of the between (interpair) and within (intrapair) effects of each measure on development were thus obtained. Neurodevelopment was assessed with the Bayley Scales of Infant Development, 2nd edition, by a psychologist blind to the exposure. A standardized neurological examination was performed by a neuropediatrician who was unaware of the exposures under investigation. After adjustment, birth weight ratio and head circumference at birth were not associated with motor or mental outcomes. Current head circumference was associated with mental but not with motor outcomes. Only the intrapair twin effect was significant. An increase of 1 cm in current head circumference of one twin compared with the other was associated with 3.2 points higher in Mental Developmental Index (95%CI = 1.06-5.32; P < 0.03). Thus, no effect of intrauterine growth was found on cognition and only postnatal head growth was associated with cognition. This effect was not shared by the co-twin.

Influence of intrauterine and extrauterine growth on neurodevelopmental outcome of monozygotic twins

There have been indications that intrauterine and early extrauterine growth can influence childhood mental and motor function. The objective of the present study was to evaluate the influence of intrauterine growth restriction and early extrauterine head growth on the neurodevelopmental outcome of monozygotic twins. Thirty-six monozygous twin pairs were evaluated at the corrected age of 12 to 42 months. Intrauterine growth restriction was quantified using the fetal growth ratio. The effects of birth weight ratio, head circumference at birth and current head circumference on mental and motor outcomes were estimated using mixed-effect linear regression models. Separate estimates of the between (interpair) and within (intrapair) effects of each measure on development were thus obtained. Neurodevelopment was assessed with the Bayley Scales of Infant Development, 2nd edition, by a psychologist blind to the exposure. A standardized neurological examination was performed by a neuropediatrician who was unaware of the exposures under investigation. After adjustment, birth weight ratio and head circumference at birth were not associated with motor or mental outcomes. Current head circumference was associated with mental but not with motor outcomes. Only the intrapair twin effect was significant. An increase of 1 cm in current head circumference of one twin compared with the other was associated with 3.2 points higher in Mental Developmental Index (95 percentCI = 1.06-5.32; P < 0.03). Thus, no effect of intrauterine growth was found on cognition and only postnatal head growth was associated with cognition. This effect was not shared by the co-twin.

[Is there room for the pediatric neurological examination in the 21st century? A contribution to clinical research on development]. / Siglo XXI. Hay espacio para el examen neuropediátrico? Contribución a la investigación clínica del desarrollo.

AIM: To underscore the importance of the pediatric neurological examination for the diagnosis, treatment and prognosis of nervous system disorders in children. For that, we reviewed the research carried out by our group in the past 40 years. DEVELOPMENT: Knowing the semiology of neurological development is essential for the neurological, psychological and motor follow-up of children. On their own, neuroimaging techniques are not sufficient to predict the long-term neurological and psychomotor consequences of perinatal events. On the other hand, the neurological examination is a sensitive method with good prognostic value, which facilitates a timely and appropriate treatment intervention. This observation has been confirmed by our research focused on the neurological examination, including the study of the developmental neurological examination in preschoolers, assessment of the psychological and neurological maturity in school age children, development of preterm-born school age children, limb-trunk coordination in premature newborns and their development, relationship between higher brain function, learning to read and write and improving the diagnosis of attention deficit/hyperactivity disorder in school children, neurological disorders in newborns, birth trauma, jaw opening reflex to appendicular compression, parachute and lateral propping reactions in newborns, neurological and psychomotor development at 6 months of corrected age in premature babies with neonatal crises and/or intracranial hemorrhage, and neurological examination in healthy newborns. CONCLUSIONS: The neuropediatrician must be aware of the importance of a comprehensive neurological history and consistent semiology to be able to request and correctly evaluate the results of ancillary tests, and thus make adequate treatment decisions.

Siglo XXI. ¿Hay espacio para el examen neuropediátrico? Contribución a la investigación clínica del desarrollo / Is there room for the pediatric neurological examination in the 21st century? A contribution to clinical research on development

Objetivo. Reforzar la importancia del examen neuropediátricopara el diagnóstico, el tratamiento y el pronóstico de laspatologías del sistema nervioso del niño. Para ese fin, revisamoslas líneas de investigación de nuestro grupo durante los últimos 40años. Desarrollo. La semiología neuropediátrica evolutiva es fundamentalpara el acompañamiento neuropsicomotor del niño. Utilizadosde forma aislada, los estudios de neuroimagen no son eficacespara predecir, a largo plazo, secuelas neuropsicomotoras derivadasde acontecimientos perinatales. Por el contrario, el examenneurológico es un método sensible y con valor pronóstico que permiteuna rápida y adecuada intervención terapéutica. Esa observaciónha sido confirmada por nuestra investigación enfocada en elexamen neurológico, que incluye el estudio del examen neurológicoevolutivo del preescolar, la evaluación de la madurez psiconeurológicadel niño en edad escolar, el desarrollo de estos prematuros enla edad escolar, la coordinación tronco-miembros en recién nacidosprematuros y su desarrollo, la relación entre las funcionescerebrales superiores y la alfabetización y perfeccionamiento deldiagnóstico de déficit de atención e hiperactividad en escolares, lapatología neurológica del recién nacido, el trauma del nacimiento,las respuestas de apertura de boca por compresión apendicular, lasreacciones de paracaídas y de apoyo lateral en el recién nacido, eldesarrollo neuropsicomotor a los 6 meses de edad corregida enlactantes prematuros con crisis neonatales y/o hemorragia intracranealy examen neurológico en el recién nacido sano. Conclusiones.El neuropediatra necesita conocer la importancia de una historianeuropediátrica completa y de una semiología consistentepara ser capaz de solicitar y evaluar correctamente los resultadosde los exámenes complementarios, y posibilitar el tratamiento adecuado

Aim. To underscore the importance of the pediatric neurological examination for the diagnosis, treatment andprognosis of nervous system disorders in children. For that, we reviewed the research carried out by our group in the past 40years. Development. Knowing the semiology of neurological development is essential for the neurological, psychological andmotor follow-up of children. On their own, neuroimaging techniques are not sufficient to predict the long-term neurologicaland psychomotor consequences of perinatal events. On the other hand, the neurological examination is a sensitive methodwith good prognostic value, which facilitates a timely and appropriate treatment intervention. This observation has beenconfirmed by our research focused on the neurological examination, including the study of the developmental neurologicalexamination in preschoolers, assessment of the psychological and neurological maturity in school age children, developmentof preterm-born school age children, limb-trunk coordination in premature newborns and their development, relationshipbetween higher brain function, learning to read and write and improving the diagnosis of attention deficit/hyperactivitydisorder in school children, neurological disorders in newborns, birth trauma, jaw opening reflex to appendicularcompression, parachute and lateral propping reactions in newborns, neurological and psychomotor development at 6 monthsof corrected age in premature babies with neonatal crises and/or intracranial hemorrhage, and neurological examination inhealthy newborns. Conclusions. The neuropediatrician must be aware of the importance of a comprehensive neurologicalhistory and consistent semiology to be able to request and correctly evaluate the results of ancillary tests, and thus makeadequate treatment decisions

[Ischemic stroke in childhood and adolescence. A study of 46 cases in the south of Brazil]. / Accidente vascular cerebral isquémico en la infancia y la adolescencia. Estudio de 46 casos en el sur del Brasil.

INTRODUCTION: Ischaemic stroke (IS) in childhood and adolescence is a condition that has received little attention from researchers and presents a multifactorial aetiology. In recent decades the rates of incidence seem to have risen, but underdiagnosis is still commonplace. It may appear as the first symptom of systemic disease in childhood, with the resulting devastating effects. Prothrombotic disorders represent important causal factors of ischaemic attacks in childhood. AIMS: The aims of this study were to identify the factors associated to IS in infancy and adolescence, as well as to establish the causation and to determine the abnormalities in the coagulation proteins of the patients that were studied. PATIENTS AND METHODS: A total of 46 patients diagnosed with IS, between 0 and 18 years of age, were included in the study over the period between March 2002 and September 2003. A number of lab tests were carried out, including analysis of coagulation proteins and echocardiograms. RESULTS: Neonatal IS was found in almost a third of the cases and practically half the sample had some disease prior to the ischaemic event. In all, 20% of the patients showed no IS-associated disorders. The most frequent clinical presenting symptoms were convulsions and hemiparesis. Anomalies were detected in proteins S and C in 22 and 17% of the sample, respectively. The middle cerebral artery was the most affected vascular region. CONCLUSIONS: IS-associated disorders were identified in most of the children and adolescents that were studied; moreover, prothrombotic risk factors are of great significance in the research into cases.

Accidente vascular cerebral isquémico en la infancia y la adolescencia. Estudio de 46 casos en el sur del Brasil / Ischemic stroke in childhood and adolescence. A study of 46 cases in the south of brazil

Introducción. En la infancia y la adolescencia el accidente vascular cerebral isquémico (AVCI) es una patología poco estudiada y con una etiología multifactorial. En las últimas décadas las tasas de incidencia parecen haber aumentado, pero el subdiagnóstico todavía es habitual. Puede ser la primera manifestación de enfermedad sistémica en la infancia y tener, como consecuencia, un efecto devastador. Importantes factores causales del accidente isquémico en la infancia son los trastornos protrombóticos. Objetivos. Identificar los factores asociados al AVCI en la infancia y la adolescencia, establecer la etiología y señalar las anormalidades en las proteínas de coagulación de los pacientes estudiados. Pacientes y métodos. En el período de marzo de 2002 a septiembre de 2003 se estudiaron 46 pacientes con diagnóstico de AVCI, de edades entre 0 y 18 años. Se realizaron exámenes en el laboratorio, que incluían proteínas de coagulación y ecocardiograma. Resultados. El AVCI neonatal se presentó en casi un tercio de los casos y casi la mitad de la muestra presentaba una enfermedad previa al suceso isquémico. El 20% de los pacientes no mostraban ninguna alteración asociada al AVCI. Los síntomas de presentación clínica más frecuentes fueron las convulsiones y la hemiparesia. Se detectaron anormalidades en las proteínas S y C en el 22 y 17% de la muestra, respectivamente. La zona vascular más afectada fue la de la arteria cerebral media. Conclusiones. Fue posible identificar alteraciones asociadas al AVCI en la mayoría de los niños y adolescentes estudiados; los factores de riesgo protrombótico son de gran relevancia en la investigación de los casos

Introduction. Ischaemic stroke (IS) in childhood and adolescence is a condition that has received little attention from researchers and presents a multifactorial aetiology. In recent decades the rates of incidence seem to have risen, but underdiagnosis is still commonplace. It may appear as the first symptom of systemic disease in childhood, with the resulting devastating effects. Prothrombotic disorders represent important causal factors of ischaemic attacks in childhood. Aims. The aims of this study were to identify the factors associated to IS in infancy and adolescence, as well as to establish the causation and to determine the abnormalities in the coagulation proteins of the patients that were studied. Patients and methods. A total of 46 patients diagnosed with IS, between 0 and 18 years of age, were included in the study over the period between March 2002 and September 2003. A number of lab tests were carried out, including analysis of coagulation proteins and echocardiograms. Results. Neonatal IS was found in almost a third of the cases and practically half the sample had some disease prior to the ischaemic event. In all, 20% of the patients showed no IS-associated disorders. The most frequent clinical presenting symptoms were convulsions and hemiparesis. Anomalies were detected in proteins S and C in 22 and 17% of the sample, respectively. The middle cerebral artery was the most affected vascular region. Conclusions. IS-associated disorders were identified in most of the children and adolescents that were studied; moreover, prothrombotic risk factors are of great significance in the research into cases

[Cerebrovascular disease as an initial finding in childhood tuberculosis meningoencephalitis]. / Enfermedad cerebrovascular como síntoma inicial de meningoencefalitis tuberculosa en la infancia.

INTRODUCTION: The prevalence of tuberculosis in developing countries, such as Brazil, remains high with important morbidity and mortality rates among children. Neurological complications are frequent and tuberculous meningo-encephalitis (TBM) is the most dreaded of them in infancy. CASE REPORT: Our case involves a 7-year-old white female patient who was previously in good health. Over a period of two weeks she suffered from high temperatures and vomiting and was given amoxicillin. She later suffered an attack of focal seizures. Electroencephalogram studies showed a temporary double focus and lesions in the left hemisphere. A cranial computerised tomography (CT) scan revealed a periventricular haemorrhage on the left side. The control CT (carried out 20 days later) showed a reduction in the haemorrhage and localised hypodensity. Owing to the suspected existence of an abscess, the patient was administered vancomycin. A new cranial CT scan (40 days after the first) showed gliosis alongside the basal nuclei with impregnation in the carotid trifurcation, which led us to suspect that we were dealing with a case of vasculitis or a granuloma. All the microbacterial cultures were negative and there was no history of contact with tuberculosis. The adenosine deaminase (ADA) value in the sample of cerebrospinal fluid (taken seven weeks after the first) was found to be 21.2 UI. Treatment was started with tuberculostatic compounds. Two weeks later the fever disappeared. The control CT scan showed decreased hypodensity and impregnation. The patient was discharged from hospital, with a slight monoparesis in the upper right limb. DISCUSSION: The presentation of a cerebrovascular disease within a context of TBM, like the case reported here, is relatively rare in the literature. We concluded that the uncommon initial symptoms of TBM, associated with the negative cultures, contributed to the delay in reaching a diagnosis. A cerebrovascular accident must be included in the clinical picture of TBM and this disease has to be taken into account when dealing with a case of cerebrovascular accident.

[Spastic tetraparesis as a sequela of bacterial meningitis]. / Tetraparesia espástica como secuela de meningitis bacteriana.

AIMS: The aim of this study is to demonstrate the incidence of spastic tetraparesis (ST) in meningitis patients in the paediatric ICU, together with the associated variables, and establish comparisons with the existing literature. PATIENTS AND METHODS: We reviewed the medical records of patients who presented symptoms of meningitis and required hospital treatment in the Paediatric ICU at the Hospital de Clínicas de Porto Alegre, between January 1985 and June 2001. In addition to the diagnosis of meningitis and the incidence of ST as a complication, we also examined the aetiological agent, sex, age at the moment of hospital admittance, length of time spent in hospital and treatment given in each case. RESULTS AND DISCUSSION. An incidence of 15.1% was found for cerebral palsy in the 112 cases of bacterial meningitis that were followed up clinically. In the patients with ST, the time spent in hospital was longer, and the frequency of seizures, intracranial hypertension and the protein concentration levels in CSF were higher (p<0.05).

Follow-up of patients with vertically-acquired HIV infection who are more than 9 years old.

The aim of this study was to assess the influence of biological markers of infection and antiretroviral therapy on the survival rate and quality of life in children with vertically-acquired HIV infection. This retrospective study was performed between August and October 2000. Outcome measures were presence of neurological disease, CD4 cell count, cranial computerized tomography (CT), electroencephalogram (EEG), use of antiretroviral agents, and mortality. The presence of neurological disease and of pathological findings in cranial computed tomography, and the lack of biological monitoring are associated with poor prognosis. Follow-up of this population should continue to allow long-term assessment of the social and biological impact of vertically-transmitted HIV.

[A study of psychomotor development in premature patients during their first year]. / Estudio del desarrollo psicomotor en pacientes prematuros durante el primer año de vida.

INTRODUCTION: It is necessary to differentiate neurological evaluation in the different stages of development, which include the premature newborn infant (PNI), the full term newborn, the unweaned baby, the child and the teenager. Several studies have shown the importance of using the corrected age when exploring the psychomotor development of premature babies. CASUISTICS AND METHOD: The population we studied was made up of a cohort of PNI who were born in the Hospital de Cl nicas de Porto Alegre and were monitored until they reached the age of 12 months. Motricity, sociability and speech were all considered. RESULTS AND CONCLUSIONS: It was possible to establish the frameworks of neurological development at the corrected ages of 3, 6, 9 and 12 months. The development of static balance was the only item among the motor aspects that did not agree with what was to be expected for the corrected age. The PNIs development was uniform, with regard to the perceptive and language functions for each corrected age. Such results reinforce the importance of studies like the one we present in this paper, since it is a period that can provide us with information that is useful for the early diagnosis of development disorders. It is also the best time to indicate psychomotor and affective stimulation, if we bear in mind the importance of the brain s plasticity during the first year of life.

Estudio del desarrollo psicomotor en pacientes prematuros durante el primer año de vida / A study of psychomotor development in premature patients during their first year

Introducción. Se necesita diferenciar la evaluación neurológica en las diferentes etapas del desarrollo, que incluye el recién nacido prematuro (RNP), a término, el lactante, el niño y el adolescente. Varios estudios han demostrado la importancia del uso de la edad corregida a la hora de estudiar el desarrollo psicomotor de los prematuros. Pacientes y métodos. La población estudiada comprendía una cohorte de RNP, a los que se les realizó un seguimiento hasta que alcanzaron los 12 meses de edad, nacidos en el Hospital de Clínicas de Porto Alegre. Se consideraron la motricidad, la sociabilidad y el habla. Resultados y conclusiones. Fue posible establecer los marcos del desarrollo neurológico a los 3, 6, 9 y 12 meses de edad corregida. El desarrollo del equilibrio estático fue el único ítem de los aspectos motores que no estuvo de acuerdo con lo esperado para la edad corregida. El desarrollo del RNP fue uniforme, al considerarse las funciones perceptivas y de lenguaje para cada edad corregida. Tales resultados refuerzan la importancia de los estudios como el que aquí se presenta, dado que es un período capaz de aportar informaciones útiles para el diagnóstico precoz de los desórdenes del desarrollo, y constituye el mejor momento para la indicación de la estimulación psicomotora y afectiva, si consideramos la importancia de la plasticidad cerebral durante el primer año de vida (AU)

[Evaluation of neuropsychomotor development in first grade children and its relation with nutrition] / Avaliação do desenvolvimento neuropsicomotor em escolares de primeira série e sua relação com o estado nutricional.

OBJECTIVE: To investigate the neurological performance of elementary school students from the city of Porto Alegre, state of Rio Grande do Sul, Brazil, in order to assess the association of neurological development and nutritional status. METHODS: We carried out an observational, analytical, and crosssectional study on a random and proportional population sample selected out of all first-grade students (n=35,521) in the city of Porto Alegre for a total of 484 children, out of which 64.7% were enrolled in state public schools, 11.9% in city public schools, and 23.4% in private schools. Our sample size allowed for a precision of -/+ 3% (95% confidence interval) for an estimated prevalence of 10% of cortical dysfunction. Children were submitted to individual examinations at the school. We collected data regarding sex, age, color of skin, nutritional status, and school of origin. An informed consent was obtained from the State and City Departments of Education and from the principals of the private schools. Statistical analysis was carried out using the chi-square test and ANOVA. RESULTS: From 11.4% to 38.2% of children presented ENE results lower than expected according to their age. The most affected factors were sensory activity and gnosia (38.2%), and the least affected factor was motor persistence (11.4%). There were no statistically significant differences between boys and girls. We observed an association of children with low height-for-age and weight-for-age and cortical dysfunction. CONCLUSIONS: Chronic malnutrition is a risk factor for brain function performance.

[Devic disease: a case report] / Doença de Devic: um relato de caso.

OBJECTIVE: To report a case of Devic disease, emphasizing its diagnosis, in addition to reviewing the medical literature. DESCRIPTION: Male, six-year-old patient suddenly developed weakness in lower limbs, with resolution during hospital stay. However, as the weakness disappeared, loss of vision occurred. The symptoms were reverted after the use of prednisone. COMMENTS: The diagnostic and therapeutic approach was similar to that used in other cases reported by different reference centers. In other words, clinical diagnosis and prednisone therapy were used, with the complete improvement of symptoms. However, there is still some controversy surrounding its etiology and relationship with other demyelinating diseases, such as multiple sclerosis.

[Prevalence of prenatal exposure to cocaine in a sample of newborns from a university teaching hospital] / Prevalência da exposição pré-natal à cocaína em uma amostra de recém-nascidos de um hospital geral universitário.

OBJECTIVE: To assess the prevalence of prenatal exposure to cocaine in a sample of newborns using two methods: fluorescence polarization immunoassay and interview with the mother. METHODS: This cross-sectional study was carried out in a university teaching hospital. The population included all live births between March 23, 1999 and June 01, 1999 (n=847). Exposure was determined by a benzoylecgonine-positive meconium specimen and/or by a positive interview with the mother. RESULTS: The prevalence of prenatal exposure to cocaine in this sample was 2.4% (16 cases) according to the interviews, and 3.4% (25 cases) according to the meconium analysis. A rate of 4.6% (34 cases) was found when both methods were associated. CONCLUSIONS: We observed that the meconium test was more effective than the maternal interview for the diagnosis of prenatal exposure to cocaine. The meconium analysis enhanced diagnostic chances by 53.4%, compared to 26% in the case of maternal interview.

Benign rolandic epilepsy: clinical and electroencephalographic correlates.

Benign rolandic epilepsy (BRE) is known for its dissociation from structural alterations. Nevertheless, the number of cases with reported organic lesions has been increasing. This led to the creation of two subgroups, "benign" and "non benign" BRE, and resulted in the need for additional parameters to define electrographic benignity. We assessed the possible associations between interictal electroencephalographic findings and clinical behavior in 60 BRE cases, testing four parameters of electrographic benignity (paroxysm morphology, horizontal dipole, base rhythms, laterality of rolandic spikes). We also assessed the relationship between neuroimaging findings and electrographic and clinical classifications, and found a statistically significant association (sensitivity=73.5%; specificity=81.8%; positive predictive value=94. 8%; negative predictive value=40.9%). Three of the electrographic parameters proposed were associated with clinical classification: paroxysm morphology, horizontal dipole, and base rhythms. Cases electrographically classified as benign have 21 times more chances to be equally classified as clinically benign according with the tested criteria.

Prevalence of attention-deficit hyperactivity disorders in students. Comparison between DSM-IV and neuropsychological criteria.

Attention-deficit hyperactivity disorder (ADHD) is a common childhood condition, recognized as an important social-medical problem. The syndrome is characterized by motor system, perception, cognition and behavioral disturbances, compromising the learning of children with adequate intellectual potential. To investigate its prevalence in first grade pupils 484 children with DSM-IV diagnostic criteria and neuropsychological criteria were examined. The prevalence of ADHD was 18% when the diagnosis was made using DSM-IV criteria; 3.5% when neuropsychological criteria was used, including, in addition to behavioral and psychometric aspects, a discrepancy in the evolutionary neurological examination, and 3.9% when motor persistence was taken into account. The prevalence of ADHD was higher among older children (92.4 months) only when DSM-IV criteria were used. We conclude that the use of DSM-IV criteria probably overestimates the prevalence of ADHD, since it detects another behavioral disorders. In this context, they may be useful as screening, since they have adequate pre-testing performance.

[Assessment through P300 of epileptic and non-epileptic children and school performance]. / Avaliação pelo P300 de crianças com e sem epilepsia e rendimento escolar.

Learning disability is common in epileptic children. Epilepsy has been associated with disorders of intelligence. Cognitive potential (P300) is considered to be a clinical aid in the neurophysiological measurement of the cognitive process. Ninety-nine children between the ages of 10 years and 11 years and 11 months formed our sample, with good and poor school performance. Group I, non-epileptic, had 64 children of whom 32 had good and 32 poor school performance. Group II, epileptic, had 35 children, of whom 21 had good and 15 poor school performance. No significant difference in P300 latency was found between Groups I and II. When groups were stratified based on school performance, Group I children with good school performance had P300 latency of 336 ms, while the ones with poor school performance had latency of 382 ms. Group II children with good school performance had P300 latency of 363, while the ones with poor school performance had latency of 400 ms. There was a statistically significant difference between the non-epileptic children with good school performance and the children with poor school performance, epileptic or not.

[Study of higher brain function in first grade students and its relationship with reading and writing acquisition]. / Estudio de las funciones cerebrales superiores en escolares de Enseñanza Primaria y su relación con la alfabetización.

INTRODUCTION: The study of higher cortical functions gives valuable information and new insights in the understanding of the complex functioning of the central nervous system. Developmental neurological examination is an important semiologic tool in the evaluation of cortical functions. OBJECTIVE: The main of this study was to evaluate, using the neurological developmental exam, cortical functions and their association with learning. PATIENTS AND METHODS: This was an observational, analytic and transversal study with a random and proportional sample (484 children) of first grade students of Porto Alegre, Brazil. Chi-square and ANOVA tests were used, with a significant p value < 0.05. RESULTS AND CONCLUSION: Results show that altered neurologic performance disturbs reading and writing acquisition. This study, showed an association between altered neurological developmental examination and WISC subtests (numbers, figure completion and code), with learning disorders.

[Prenatal exposure to cocaine: review of the neurobehavioral effects] / Exposição pré-natal à cocaína: revisão dos efeitos neurocomportamentais.

OBJECTIVE: To study prenatal cocaine exposure, emphasizing its behavioral effects. METHODS: Literature review of the last 15 years, through Medline and direct search. RESULTS AND CONCLUSIONS: According to the literature, the incidence of prenatal cocaine exposure is up to 15.5%, and its effects on the newborn are particularly on the development of the nervous system. Pediatricians and sub-specialists must know the consequences of such exposure in order to diagnose and affect the prognosis of these children.

[Aids neurologic manifestations in childhood]. / Manifestaciones neurológicas del SIDA en la infancia.

INTRODUCTION: Children with AIDS get infected mainly by vertical transmission. DEVELOPMENT: That was what happened in 90% of the cases in a series of 340 HIV+ children followed at Hospital de Clínicas de Porto Alegre, Brazil. Currently, after the use of prophylactic treatment during pregnancy and the six first weeks of life, our transmission rate is 3% to 4%. The incidence of neurologic complications in the vertical transmission group was 49% in our prospective series, and due either to immunosuppression or primary neurological disease. Neurologic changes secondary to HIV constitute a complex syndrome, manifested by various degrees of cognitive, motor and behavioral delay. Encephalopathy can be either progressive or static. In our series, encephalopathy occurred in 32.5% of cases, developmental delay in 42.5%, seizures in 6%, speech delay in 5%, headaches in 2.5% and behavioral disorders in 2%. Central nervous system infections happened in 33.8% of our cases: acute bacterial infections in 11%, cytomegalovirus in 6.8%, toxoplasmosis in 5.9%, cryptococcal in 5%, tuberculous in 3.8% and syphilis in 1.3%. Hemorrhagic cerebrovascular accidents were seen in 2.5% of our cases, and peripheral neuropathy in 5%. Seventy percent of our cases had abnormalities in the CSF, 75% in brain CT scans and 45% in EEGs. CONCLUSIONS: Treatment of children with AIDS and neurologic manifestations was based on specific drugs aimed at controlling viral replication. Best response was obtained with combined use of AZT and other anti-retroviral neuro-protective.