ABSTRACT
Seizures are the most acute evident manifestation of central nervous system dysfunction in neonates. The incidence is higher in very low weight neonates, about 58/100 live births, as opposed to full-term infants, estimated about 3.5/100 live births. Neonatal seizures represent the clinical manifestation of a non-specific disorder of cortical cerebral dysfunction, which could lead to permanent brain injury. The etiology is multifactorial and requires a judicious assessment of each clinical scenario. The diagnosis and its management are further complicated as most neonatal seizures may have very subtle or no clinical changes and the diagnosis may be just based on EEG findings, so-called subclinical. The treatment is dependent on the etiology, but early and opportune intervention can prevent further brain damage and improve prognosis. Although early identification and treatment are essential, the diagnosis of neonatal seizures can be further complicated by the clinical presentations, possible etiologies, and treatments. Nevertheless, research studies and clinical evidence have shown that early treatment with anti-seizure medications can change the outcome.
ABSTRACT
Pediatric epilepsy presents with various diagnostic challenges. Recent advances in neuroimaging play an important role in the diagnosis, management and in guiding the treatment of pediatric epilepsy. Structural neuroimaging techniques such as CT and MRI can identify underlying structural abnormalities associated with epileptic focus. Functional neuroimaging provides further information and may show abnormalities even in cases where MRI was normal, thus further helping in the localization of the epileptogenic foci and guiding the possible surgical management of intractable/refractory epilepsy when indicated. A multi-modal imaging approach helps in the diagnosis of refractory epilepsy. In this review, we will discuss various imaging techniques, as well as aspects of structural and functional neuroimaging and their application in the management of pediatric epilepsy.
ABSTRACT
AIM: To evaluate the utility of magnetic resonance imaging (MRI) in children with mild traumatic brain injury (mTBI), persistent post-concussive syndrome (PPCS), and normal neurologic examination. MATERIALS AND METHODS: This was a retrospective review of pediatric patients, who were evaluated in a Pediatric Concussion Clinic between August 2013 and November 2018, with documented persistent post-concussive symptoms, normal neurological examination, and available brain MRI. RESULTS: In our analysis of 86 cases we found seven MRI studies with abnormal findings, but none were clinically significant. CONCLUSION: We conclude that MRI has a low diagnostic yield in this population, and based on these results we recommend that clinicians should avoid ordering MRI studies in this group. Further research is necessary to validate these results in larger and prospective studies.
ABSTRACT
Echinococcosis, also known as Hydatid disease, is caused by the larvae of the tapeworm Echinococcus. It is globally prevalent and is a major clinical health concern. It is endemic in most underdeveloped regions including Asia, the Mediterranean, South America and Africa. There are four species within the genus Echinococcus, with E. granulosus and E. multilocularis being the most common, causing Cystic Echinococcosis (CE) and Alveolar Echinococcosis (AE). The clinical presentation of the disease is non-specific. It commonly involves the liver, lungs, brain and adrenal glands. Pulmonary disease is significant for its propensity to affect children and young adults. This young population accounts for â¼50% of pulmonary hydatid cysts [1]. Cysts are known to grow extensively in size. Many patients are asymptomatic and have only a solitary cyst. Symptoms arise from enlargement of the cyst and from eroding and pressure applied by the cyst to blood vessels and organs. If rupture of the cyst occurs it can lead to immunologic reactions such as asthma and anaphylaxis. Echinococcus in the lung can pose diagnostic dilemmas, as their homogeneous density and tendency to occur alone may cause them to be confused with squamous cell carcinoma, adenocarcinoma, solitary metastasis, and abscess [2]. Our case is of such a patient who was found to have a 6 cm mass in the right middle lobe (RML) found on a chest X-ray during evaluation of back pain. Echinococcus should always be included in a differential diagnosis of any mass lesions especially in immigrant populations from endemic countries.
ABSTRACT
Neonatal seizures are among the most dramatic manifestations of acute central nervous system dysfunction. The incidence is much higher in very low weight neonates than in full term infants (Ë 58 and 3.5 per 100 live births, respectively). Neonatal seizures represent the clinical manifestation of a non-specific cortical cerebral dysfunction which can lead to permanent brain injury. The etiology is multifactorial and requires a judicious assessment for each clinical scenario. The diagnosis is further complicated by the fact that most neonatal seizures are subclinical, that is, may display very subtle or no clinical changes and the diagnosis may just be based on EEG findings. The treatment depends on the etiology, but an early and opportune intervention prevents further brain damage, thus improving prognosis. Although early identification and treatment are critical, the diagnosis of neonatal seizures is complicated by several factors such as different clinical presentations, possible etiologies and several treatment options. Nevertheless, research studies and clinical evidence have shown that early treatment with anti-seizure medications can change the outcome.
Subject(s)
Anticonvulsants/therapeutic use , Seizures/drug therapy , Anticonvulsants/classification , Electroencephalography , Humans , Infant, Newborn , Prognosis , Seizures/diagnosisABSTRACT
Las convulsiones neonatales están entre las manifestaciones más dramáticas de enfermedad neurológica y deben ser consideradas una emergencia. La incidencia es 3.5 por cada 100 nacidos a término y en prematuros asciende a 58 por cada 100 nacidos vivos. Las convulsiones neonatales son una manifestación clínica de disfunción cortical no específica que puede dar lugar a daño permanente del cerebro. La etiología es multifactorial y requiere una evaluación cuidadosa de cada escenario clínico. El diagnóstico es más complejo por el hecho de que la mayoría de convulsiones son sub-clínicas o sutiles y a veces no tienen correlación con el electroencefalograma. Aunque la identificación temprana y el tratamiento son críticos, el diagnóstico se complica por algunos factores como la variedad de presentaciones clínicas, diferentes etiologías y varias alternativas de tratamiento. De todas maneras, los estudios de investigación y la evidencia clínica disponible han demostrado que el tratamiento precoz con fármacos anticonvulsivantes puede mejorar el pronóstico.
Neonatal seizures are among the most dramatic manifestations of acute central nervous system dysfunction. The incidence is much higher in very low weight neonates than in full term infants (~58 and 3.5 per 100 live births, respectively). Neonatal seizures represent the clinical manifestation of a non-specific cortical cerebral dysfunction which can lead to permanent brain injury. The etiology is multifactorial and requires a judicious assessment for each clinical scenario. The diagnosis is further complicated by the fact that most neonatal seizures are subclinical, that is, may display very subtle or no clinical changes and the diagnosis may just be based on EEG findings. The treatment depends on the etiology, but an early and opportune intervention prevents further brain damage, thus improving prognosis. Although early identification and treatment are critical, the diagnosis of neonatal seizures is complicated by several factors such as different clinical presentations, possible etiologies and several treatment options. Nevertheless, research studies and clinical evidence have shown that early treatment with anti-seizure medications can change the outcome.
