[The influence of child's behaviour on the course of neurological diagnosis]. / Wplyw zachowania dziecka na przebieg diagnozy neurologicznej.

INTRODUCTION: Among the huge amount of neurological diseases that cause diagnostic difficulties, there happens, from time to time an additional difficulty--disorders of psychogenic origin, and among those- conversion disorders. Until now there still is no satisfactionary explanation for the neurobiological basis of conversion. The explanations offered by psychology are also rather general, based on the tradition of psychoanalysis. Aside from how deeply one understands its mechanisms, when suspecting a psychogenic origin of the symptoms observed, one should be especially careful. It is far too easy falling in the trap, that hysteria sets for us, suggesting to be the patient's one and only disease that should be dealt with. AIM OF THE STUDY: To show the difficulties and dangers when making a diagnosis of functional disorders, both from the physician's and psychologist's point of view. MATERIAL AND METHODS: Presenting cases of 6 patients, whose behaviour and symptom presentation suggested a psychogenic background of the disorders, and only few of the psychological tests' results differentiated between the organic and the psychogenic group. RESULTS: In the presented group there were 3 children diagnosed with conversion disorder, and 3 diagnosed with neurological diseases. The psychological test results only partly differentiated between both groups, not allowing any interpretation to be based on quantitative results only. CONCLUSIONS: 1. Even though medicine has made such a huge step forward, conversion disorders can still cause serious diagnostic difficulties. 2. Leaving our knowledge about human mind aside, we are continously eager to base our judgement on the most vivid elements, that present to us most clearly. 3. That line of thinking puts us in jeopardy of missing the obvious: that a histerical person can also suffer from another condition of a very organic origin.

[Migrainous aura subtypes in hospitalized children]. / Rodzaje aury migrenowej u hospitalizowanych dzieci.

INTRODUCTION: Migraine with aura is characterized by reversible focal neurological symptoms preceding or accompanying headache. Visual aura is the most common type of aura and its patognomic symptoms are scintillating fortification migrating across the visual field or scintillating scotoma. However, the symptoms are not always so typical and clinical doubts are greater when negative symptoms (loss of vision, numbness or paresis) are present. Differential diagnosis of migraine with aura includes in the first place transient ischemic attack (TIA) as well as epilepsy. Diagnosis of migraine in the developmental age is more difficult and associated with unprecise description of the symptoms. Thorough history taking is crucial in migraine diagnosis and following management. Knowledge of migraine with aura symptoms, clinical differences associated with developmental age and features enabling differentiation with other disorders imitating migraine is very important. AIM OF THE STUDY: Description of aura types and characteristics of migraine headache and their accompanying symptoms in children. MATERIAL AND METHODS: 30 children were included, aged 8-17 years (mean 13,6 years), hospitalized at Department of Pediatric Neurology Chair of Pediatric and Adolescent Neurology, Jagiellonian University in 14 months of years 2008 and 2009. Clinical analysis was based on inquiry addressed to the patients and their parents. RESULTS: Migraine with visual aura was established in 9 patients, with somatosensory aura in 4, visual and somatosensory in 5, visual and dysphasic in 1, visual, somatosensory and dysphasic in 5, somatosensory and dysphasic in 2 and basilar type migraine in 4 patients. Consequently, symptoms of visual aura were present in 20/30 patients, in 9 of them it was the only type of aura and in 11 coexisted with other aura types. In more than half cases it manifested as simple visual phenomenons (spots, dots, frills, lines). Blurred vision was found in 5 patients (bilateral in 3, unilateral in 3) and hemianopia in 2 (bilateral in aura was observed in 16/30 patients and only in 4 of them it occurred without other aura symptoms. Dysphasic aura accompanied other aura types in 8 cases. Basilar type migraine was established in 4 patients. Unilateral migrainous headache occurred in 20/30 patients. Pain intensity was defined as very severe, severe and moderate in the following 10, 12 and 8 patients. Pulsating quality of the pain was found in 15 cases. Aggravation of headache by movement was observed in 22/30 patients. Nausea was the most common accompanying symptom present in 20/30 patients. Vomiting, photophobia and phonophobia occurred in 15 patients each. Coexistence of nausea and/or vomiting, photo- and phonophobia was reported in 12 cases. Vertigo and balance disturbances were frequently found additional symptoms and occurred in 11 and 2 patients and in 6 coexisted together. Positive family history of migraine was reported in 18/30 patients. CONCLUSIONS: 1. Visual and somatosensory aura were the most frequent types of aura in children; basilar-type aura occurred with the lowest frequency. 2. Unilateral headache with severe or very severe pain intensity, aggravated by movement was found in more than half cases. Pulsating quality of headache was present in half of the patients. 3. Accompanying symptoms (nausea, vomiting, photo- and phonophobia) occurred in the combination, fulfilling ICHD II diagnostic criterion D for migraine in less then half cases. Vertigo and/or balance disturbances, were commonly found symptoms with no association to aura type. 4. Familial occurrence of migraine was reported in more than half patients. 5. Another modification of migraine diagnostic criteria for children is needed. 6. History takes crucial role in the diagnosis of childhood migraine.

[Visual perception deficits of cortical origin]. / Zaburzenia percepcji wzrokowej pochodzenia korowego.

This work comprises of a literature review on visual perception distortions that have their origin in structural or functional irregularities of the brain, resulting in the cortex malfunction. The main area that we pay attention to is the brain cortex, but we should not forget, that diseases destructive to the lower brain structures also inevitably lead to secondary dysfunction of the cortex, and thus they have also been included in this paper. Cerebral vision disorders are a small percentage of caseload in either neurology or ophthalmology practice, yet they certainly are interesting for the cognitive scientists, as they open a window into the complex mechanisms of the cerebral clockwork. We are presenting examples of disorders, many of which engage the creative cooperation between specialists from different fields of neuroscience. Three kinds of disorders are presented: vision loss, agnosias and hallucinations. Among others there is some information on cortical blindness, blindsight, Anton's syndrome, hysterical blindness, apperceptive and associative agnosia, prosopagnosia, pure alexia, achromatopsia, Bonnet syndrome, Alice in Wonderland syndrome, peduncular halucinosis etc.

[Verbal fluency test--developmental aspects in health and illness]. / Test fluencji slownej--aspekty rozwojowe w normie i patologii.

INTRODUCTION: The Verbal Fluency Test is one of the easiest method in the neuropsychological evaluation of the frontal and temporal lobes' functioning. The amount of reasearch considering children's performance is still small compared to the adult population. The test lacks polish norms (as well as norms for children in other countries, except for unique cases). AIM OF THE STUDY: it was to present possible methods of quality and quantity analysis of the Verbal Fluency Test, and the statistical interpretation of children's performance, depending on the general result, age and diagnosis. MATERIAL AND METHODS: the research was done on a group of 80 children, aged 6-17, including 50 girls and 30 boys, who were hospitalized during the yeras 2007/2008 in the Department of Pediatric Neurology Chair of Pediatric and Adolescent Neurology Jagiellonian University in Krakow. The children were diagnosed with epilepsia (44 children) or headache (36 children). The Verbal Flunecy Test was used in the neuropsychological evaluation among other methods, such as Rey Osterrieth Compex Figure test, Clock test, and intelligence tests WISC-R and WAIS-R(PL). RESULTS: the results confirm the charakter of the method, as a executive rather than memory function measure. The general result was influenced mainly by the ability to switch between specific subcategories. The general result correlated with age and gender, also children with headache performed better than children with epilepsia. CONCLUSIONS: Apropriately interpreted, especially considering quality analysis, the Verbal Fluency test is a valuable tool in the differential diagnosis in children, and detection of subtle weakening in the development of certain cognitive abilities. It is crucial to gather appropriate normative data for the population of children in Poland, which would enable the test's use in more general practice, as one of the early detection methods in the diagnosis of developmental disorders.

[Significant neuropsychological impairment in children with normal MRI results]. / Istotne deficyty neuropsychologiczne u dzieci z prawidlowym wynikiem neuroobrazowania MR.

The aim of the present work was to present significant cognitive impairment in 7 children with normal neuroimaging and electroencefalography results. In 6 children we observed difficulties in verbal auditory learning, in 3 visual memory impairment, and in 1 a disorder of visuo-spatial analysis and synthesis abilities. The clinical examinations performed during the diagnostic process (MRI, CT, Eeg) revealed no neurobiological correlates of the observed neuropsychological impairment. The authors used the cases described to remind, that even though current neuroimaging techniques seem excitingly promising in the diagnostic process, psychological and neuropsychological assessment remains the most sensitive method for the measurment and description of cognitive functions.

[A pediatric neuropsychological evaluation]. / Diagnoza neuropsychologiczna u dzieci.

BACKGROUND: Pediatric neuropsychology is currently one of the most expansive fields of psychology, developing between clinical neurology and other neurosciences. THE AIM OF STUDY: This work presents the main possibilities of a pediatric neuropsychological evaluation in known clinical situations and the status of the neuropsychological profession. DESCRIPTION: The necessity of evaluating the level of cognitive functioning in children from high risk groups, children with somatic, behavioural, emotional or developmental disorders was reminded. Clinical examples are described, when a neuropsychological evaluation of the child reveals important information, becoming a valuable part of the medical diagnosing process. Diagnostic methods most commonly used for assessing the level of cognitive functioning are presented, baring in mind its division into specific cognitive domains: executive functions, learning and memory, attention, visuo-motor and verbal skills. Most popular of the international and domestic IQ tests are described, including suggestions about testing children with various degrees of intellectual disability. Among the methods are tests for assessing children in age groups from 0-18. The authors described a neuropsychological interpretation of the evaluation results, including tests, behavioural observation, interviews and other diagnostic methods. Some limitations of the neuropsychological assessment methods are also mentioned, such as questionable ecological validity. CONCLUSION: the knowledge of possibilities and the necessity of the neuropsychological evaluation in children should become much more common, especially in the medical environment. The status of the neuropsychologist in Poland need a precise legal regulation.