Resonancia magnética funcional de reposo en el trastorno por déficit de atención e hiperactividad / Resting state functional magnetic resonance imaging in attention deficit hyperactivity disorder

OBJETIVOS: Explorar si los niños y adolescentes con trastorno por déficit de atención e hiperactividad (TDAH) tienen alterada la conectividad funcional entre la red de control ejecutivo y la red neuronal por defecto. MATERIAL Y MÉTODOS: Estudio exploratorio de prueba diagnóstica, prospectivo, con diseño de casos y controles. Se reclutaron consecutivamente 56 participantes (29 con TDAH de tipo inatento o combinado y 27 controles) entre 7 y 16 años, de sexo masculino, dominancia derecha. Se aplicaron los criterios diagnósticos del DSM-5 como prueba de referencia y una batería de pruebas neuropsicológicas para confirmar el diagnóstico y evaluar comorbilidades. Se les realizó resonancia magnética funcional de reposo como prueba índice. La aplicación y evaluación de las pruebas fue ciega. Las regiones cerebrales se escogieron a priori y se usó técnica de región de interés. Se evaluó la conectividad funcional de la corteza del cíngulo anterior (CCA) con el precuneus (P), la corteza del cíngulo posterior (CCP) y la corteza prefrontal dorsomedial (CPDM). RESULTADOS: Las conectividades funcionales en cada una de las asociaciones evaluadas en los pacientes con TDAH comparado con los controles fueron: P_D=0,41 vs. 0,44; CCP_D=0,43 vs. 0,53; CPDM_D=0,75 vs. 0,79; P_I=0,40 vs. 0,41; CCP_I=0,48 vs. 0,53; CPDM_I=0,76 vs. 0,72). D: lado derecho I: lado izquierdo. Valor de p> 0,05. CONCLUSIÓN: La conectividad funcional cerebral en estado de reposo es menor en los pacientes con TDAH cuando se compara con controles sanos; sin embargo, la diferencia no fue estadísticamente significativa

OBJECTIVE: To explore whether children and adolescents with attention deficit/hyperactivity disorder (ADHD) have altered the functional connectivity between the executive control network and the default mode network. METHODS: Exploratory study of a diagnostic test, prospective, case and control design. A total of 56 participants were recruited consecutively (29 inattentive or combined ADHD subtype and 27 controls) between 7 and 16 years old, male, right dominance. DSM-5 was applied as reference test and a battery of neuropsychological tests to confirm the diagnosis and assess comorbidities. Resting state functional magnetic resonance imaging was performed as an index test. The application and evaluation of the tests was blind. The brain regions were chosen a priori and the region of interest technique was used. The functional connectivity of the anterior cingulate cortex (ACC) was evaluated with: the precuneus (P), the posterior cingulate cortex (PCC) and the dorsomedial prefrontal cortex (DMPC). RESULTS: The functional connectivity in each of the associations evaluated in the patients with ADHD compared with the controls were: P_D=0.41 vs 0.44; CCP_D=0.43 vs 0.53; CPDM_D=0.75 vs. 0.79; P_I=0.40 vs 0.41; CCP_I=0.48 vs 0.53; CPDM_I=0.76 vs. 0.72). D: right side I: left side. Value of p> 0.05. CONCLUSION: Cerebral functional connectivity at rest is lower in ADHD patients when compared with healthy controls, however, the difference was not statistically significant

Resting state functional magnetic resonance imaging in attention deficit hyperactivity disorder. / Resonancia magnética funcional de reposo en el trastorno por déficit de atención e hiperactividad.

OBJECTIVE: To explore whether children and adolescents with attention deficit/hyperactivity disorder (ADHD) have altered the functional connectivity between the executive control network and the default mode network. METHODS: Exploratory study of a diagnostic test, prospective, case and control design. A total of 56 participants were recruited consecutively (29 inattentive or combined ADHD subtype and 27 controls) between 7 and 16 years old, male, right dominance. DSM-5 was applied as reference test and a battery of neuropsychological tests to confirm the diagnosis and assess comorbidities. Resting state functional magnetic resonance imaging was performed as an index test. The application and evaluation of the tests was blind. The brain regions were chosen a priori and the region of interest technique was used. The functional connectivity of the anterior cingulate cortex (ACC) was evaluated with: the precuneus (P), the posterior cingulate cortex (PCC) and the dorsomedial prefrontal cortex (DMPC). RESULTS: The functional connectivity in each of the associations evaluated in the patients with ADHD compared with the controls were: P_D=0.41 vs 0.44; CCP_D=0.43 vs 0.53; CPDM_D=0.75 vs. 0.79; P_I=0.40 vs 0.41; CCP_I=0.48 vs 0.53; CPDM_I=0.76 vs. 0.72). D: right side I: left side. Value of p> 0.05. CONCLUSION: Cerebral functional connectivity at rest is lower in ADHD patients when compared with healthy controls, however, the difference was not statistically significant.

[Clinical and radiological findings in two cases of aspergillosis of the central nervous system in children]. / Hallazgos clínicos y radiológicos de dos casos de aspergilosis del sistema nervioso central en niños.

INTRODUCTION: Aspergillosis is the second fungemia after candidiasis that affects the central nervous system of immunodeppresed and immunocompetent humans. The literature reports nearly always compromised adults. CASE REPORTS: Two pediatric cases of central nervous system aspergillosis with different clinical course are presented. The first of them, is a immunocompetent person in whom a granulomatous disease of the central nervous system was suspected. The cultivation of stereotaxic biopsy reported thin septated hyphae. After 42 days of treatment with itraconazol the patient recovered completely. The second patient, had an acute lymphoblastic leukemia and developed a widespread aspergillosis including the central nervous system. In spite of antifungic treatment for 63 days, he died of heart failure. CONCLUSIONS: Diagnosis of aspergillosis is difficult because of the poor specificity of the neuroimages, cerebrospinal fluid and complementary labs. The images are indistinguishable from acute ischemia infarcts and later those images change to abscesses. Direct KOH staining and the cultivation of biopsed samples confirmed the diagnosis of aspergillosis. An aggressive treatment with amphotericin B and itraconazol is recommended, but high mortality is suspected. Diagnosis, neuroimaging, clinical evolution and treatment are discussed.

Hallazgos clínicos y radiológicos de dos casos de aspergilosis del sistema nervioso central en niños / Clinical and radiological findings in two cases of aspergillosis of the central nervous system in children

Introducción. La aspergilosis del sistema nervioso central (SNC) es la segunda fungemia después de la candidiasis, que afecta tanto a pacientes inmunosuprimidos como inmunocompetentes. La literatura informa fundamentalmente sobre afectación en adultos. Casos clínicos. Se presentan dos casos pediátricos con curso diferente de la afectación del SNC por aspergilosis. El primero de ellos es un paciente inmunocompetente en quien se sospechó una enfermedad granulomatosa del SNC. El cultivo por biopsia estereotáxica describió hifas septadas delgadas. Después de 42 días de tratamiento el paciente se recuperó completamente. El segundo paciente fue portador de una leucemia linfoblástica aguda, quien desarrolló una aspergilosis generalizada, con afectación del SNC. A pesar del tratamiento antifúngico por 63 días, falleció por insuficiencia cardíaca. Conclusiones. La dificultad diagnóstica consiste en la poca especificidad en el cambio del líquido cefalorraquídeo, las neuroimágenes y los exámenes complementarios. Las imágenes muestran hallazgos indistinguibles en la fase aguda de infartos isquémicos, y posteriormente se observan abscesos en vía de resolución. Solo el estudio de KOH directo y posteriormente el cultivo de las muestras biopsiadas confirmó la aspergilosis. No necesariamente un tratamiento agresivo con anfotericina B asociada a itraconazol garantiza una buena sobrevida. Se discuten el diagnóstico, los hallazgos imaginológicos, la evolución clínica y el tratamiento (AU)

Introduction. Aspergillosis is the second fungemia after candidiasis that affects the central nervous system of immunodeppresed and immunocompetent humans. The literature reports nearly always compromised adults. Case reports. Two pediatric cases of central nervous system aspergillosis with different clinical course are presented. The first of them, is a immunocompetent person in whom a granulomatous disease of the central nervous system was suspected. The cultivation of stereotaxic biopsy reported thin septated hyphae. After 42 days of treatment with itraconazol the patient recovered completely. The second patient, had an acute lymphoblastic leukemia and developed a widespread aspergillosis including the central nervous system. In spite of antifungic treatment for 63 days, he died of heart failure. Conclusions. Diagnosis of aspergillosis is difficult because of the poor specificity of the neuroimages, cerebrospinal fluid and complementary labs. The images are indistinguishable from acute ischemia infarcts and later those images change to abscesses. Direct KOH staining and the cultivation of biopsed samples confirmed the diagnosis of aspergillosis. An aggressive treatment with amphotericin B and itraconazol is recommended, but high mortality is suspected. Diagnosis, neuroimaging, clinical evolution and treatment are discussed (AU)