[Metopic suture craniosynostosis: sodium valproate teratogenic effect. Case report]. / Cranioestenose da sutura metópica: efeito teratogênico do valproato de sódio. Relato de caso.

OBJECTIVE: the aim of this report is to warn that sodium valproate used during pregnancy can produce craniosynostosis in the newborn, particularly trigonocephaly. METHOD: we describe a case of trigonocephaly in a six month-old girl, daughter of a young non-smoker couple, whose mother had used phenobarbital 100 mg daily and sodium valproate 500 mg twice daily during the whole pregnancy. We also review current literature about this topic. RESULT: bone sclerosis over the metopic suture was confirmed during surgery. Bibliographical review yields previous reports on valproate teratogenicity, mainly determining metopic suture craniosynostosis. CONCLUSION: sodium valproate used during pregnancy can produce craniosynostosis by teratogenic effect, specially trigonocephaly (premature fusion of metopic suture).

[Neurological manifestations in the intoxication of infants by dimethicone combined with homatropine: report of 6 cases]. / Manifestações neurológicas na intoxicação de lactentes pela associação dimeticona e homatropina: relato de 6 casos.

OBJECTIVE: to alert that use of dimethicone plus homatropine in infants up to two months, may cause episodes of transitory extrapyramidal disturbances. METHOD: report 6 infants up to two months old, in daily use of dimethicone plus homatropine, that presented typical symptoms of the basal ganglia dysfunction, characterized by repeated crisis of short duration with tonic back shift of the head (opisthotonos), deviation of the eyes upward with looking fixed and terror expression, maintained in extending hypertonia posture of the 4 members and cry and/or guttural sounds emission. RESULTS: the extrapyramidal symptoms disappeared (and did not return) after interruption of dimethicone plus homatropine. Abnormalities were not verified in neurological examination, EEG and blood tests. CONCLUSIONS: the associated dimethicone/homatropine can produce in infants with less than 2 months, basal ganglia disturbances. The differentiation of these symptoms with the widespread epileptic crisis is essential, in order to avoid the erroneous use of antiepileptic drugs.