Comparative Assessment of Crohn's Disease Activity Using Magnetic Resonance Enterography and Endoscopy.

Introduction Magnetic resonance enterography (MRE) has emerged as a promising technique for evaluating the extent and severity of Crohn's disease activity. To compare how we measure Crohn's disease activity with MRE and endoscopy. Material and methods We retrospectively reviewed MRE studies of 60 patients with suspicious Crohn's disease who underwent 1.5-T MRI examinations (T1-weighted images pre- and post-IV contrast medium administration and T2-weighted images) and endoscopy within one month, and they were evaluated by one radiology consultant with experience of 17 years. Endoscopy was used as the reference standard for diagnosing active Crohn's disease cases. Data analysis was performed using the websites (www.graphpad.com and www.medcalc.org) and Microsoft Excel (Microsoft® Corp., Redmond, USA). Results A total of 35 patients were included in the study. The remaining 25 patients were excluded either due to non-available data in the endoscopy report or cases of non-Crohn's disease. The MRI examinations were reviewed by one radiology consultant and revealed 27 active and eight non-active Crohn's disease cases compared to 30 active and five non-active Crohn's disease cases in endoscopy. The sensitivity of MRI in detecting active cases of Crohn's disease compared to endoscopy was 83.3% and the specificity of 60%. The strength of agreement between both methods was fair to good (Kappa = 0.347, p-value = 0.4497, Chi-squared = 0.571 with one degree of freedom). Conclusion MRE statistically has a good impact on the assessment of Crohn's disease as well as endoscopy with the parameters used in this study. Non-invasiveness and the changes of activity seen in the bowel proximal to the ileocecal junction undetectable by endoscopy make MRE more practically applicable in this aspect.

Pediatric Fulminant Cerebellitis Is Still a Fatal Disease that We Know Little About! Two Case Reports and a Literature Review.

BACKGROUND Acute cerebellitis is a rare inflammatory disease with a variable clinical course that ranges from self-limiting illness with a benign outcome to a fulminant process (known as fulminant cerebellitis) associated with high risk of morbidity and mortality. It poses a unique challenge to the pediatric community due to its infrequent occurrence and variable presentation, which ultimately contribute to variation in treatment and variation in clinical outcome. This condition has received little attention, with scattered case reports and reviews in the literature and no clear consensus or guidelines for pediatricians to standardize the approach and management. CASE REPORT We report the cases of 2 previously healthy children diagnosed with fulminant cerebellitis. The clinical picture started with severe headache, irritability, and acute deterioration of consciousness level with the absence of cerebellar signs. There was radiological evidence of obstructive hydrocephalus and cerebellar tonsillar herniation in the context of the inflamed cerebellum. The 2 patients received timely standard medical and surgical management for acute cerebellitis in the form of neuroprotective measures, osmotherapy, broad-spectrum antibiotics, and CSF diversion. One patient received aggressive immunomodulatory therapy and had a better outcome compared with the other patient who received no immunomodulatory therapy and had a poor outcome. CONCLUSIONS A high index suspicion and early aggressive intervention are the best tools for achieving optimal outcomes in fulminant cerebellitis in children, given the lack of classic cerebellar signs. In addition to CSF diversion and broad-spectrum antibiotics and antivirals, some patients may benefit from early immunomodulator therapy and posterior fossa decompressive craniotomy.

Identifying Clinical Clues in Children With Global Developmental Delay / Intellectual Disability With Abnormal Brain Magnetic Resonance Imaging (MRI).

Global developmental delay / intellectual disability are common pediatric conditions. Brain magnetic resonance imaging (MRI), although an important diagnostic tool in the evaluation of these patients, often requires general anesthesia. Recent literature suggests that unnecessary general anesthesia exposure should be avoided in early years because of possible long-term negative neurodevelopmental sequelae. This study sought to identify clinical clues associated with brain MRI abnormalities in children with global developmental delay / intellectual disability in an attempt to provide guidance to physicians on selecting patients who would benefit from an MRI. Retrospective chart review analysis was conducted for patients presenting to a pediatric neurology tertiary care center between 2014 and 2017 for a first clinic evaluation for global developmental delay / intellectual disability. Detailed clinical history and physical examination findings were analyzed and correlated with brain MRI findings. The majority (218/327, 67%) of children referred for evaluation of global developmental delay / intellectual disability underwent complete clinical and radiologic evaluations. Mean age was 37.9 months (±32.5 standard deviation) and 116 were males (53%). Motor deficits were predominant in most subjects (122/218, 56%). Abnormal MRI findings were observed in 153 children (70%), with the most prevalent abnormalities noted within the white matter (104/153, 68%), corpus callosum (77/153, 50%), and the hippocampus (50/153, 33%). Abnormal MRI findings were prevalent in children with predominant motor delay (84, 69%) and cognitive disability (3, 100%) as well as those with visual and hearing impairment (P < .05). The presence of facial dysmorphisms (57/71, P = .02); cranial nerve abnormalities (79/100; P = .007) and abnormal reflexes (16, P = .01) on examination also correlated significantly with increased MRI abnormalities.