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There have been indications that intrauterine and early extrauterine growth can influence childhood mental and motor function. The objective of the present study was to evaluate the influence of intrauterine growth restriction and early extrauterine head growth on the neurodevelopmental outcome of monozygotic twins. Thirty-six monozygous twin pairs were evaluated at the corrected age of 12 to 42 months. Intrauterine growth restriction was quantified using the fetal growth ratio. The effects of birth weight ratio, head circumference at birth and current head circumference on mental and motor outcomes were estimated using mixed-effect linear regression models. Separate estimates of the between (interpair) and within (intrapair) effects of each measure on development were thus obtained. Neurodevelopment was assessed with the Bayley Scales of Infant Development, 2nd edition, by a psychologist blind to the exposure. A standardized neurological examination was performed by a neuropediatrician who was unaware of the exposures under investigation. After adjustment, birth weight ratio and head circumference at birth were not associated with motor or mental outcomes. Current head circumference was associated with mental but not with motor outcomes. Only the intrapair twin effect was significant. An increase of 1 cm in current head circumference of one twin compared with the other was associated with 3.2 points higher in Mental Developmental Index (95%CI = 1.06-5.32; P < 0.03). Thus, no effect of intrauterine growth was found on cognition and only postnatal head growth was associated with cognition. This effect was not shared by the co-twin.

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There have been indications that intrauterine and early extrauterine growth can influence childhood mental and motor function. The objective of the present study was to evaluate the influence of intrauterine growth restriction and early extrauterine head growth on the neurodevelopmental outcome of monozygotic twins. Thirty-six monozygous twin pairs were evaluated at the corrected age of 12 to 42 months. Intrauterine growth restriction was quantified using the fetal growth ratio. The effects of birth weight ratio, head circumference at birth and current head circumference on mental and motor outcomes were estimated using mixed-effect linear regression models. Separate estimates of the between (interpair) and within (intrapair) effects of each measure on development were thus obtained. Neurodevelopment was assessed with the Bayley Scales of Infant Development, 2nd edition, by a psychologist blind to the exposure. A standardized neurological examination was performed by a neuropediatrician who was unaware of the exposures under investigation. After adjustment, birth weight ratio and head circumference at birth were not associated with motor or mental outcomes. Current head circumference was associated with mental but not with motor outcomes. Only the intrapair twin effect was significant. An increase of 1 cm in current head circumference of one twin compared with the other was associated with 3.2 points higher in Mental Developmental Index (95 percentCI = 1.06-5.32; P < 0.03). Thus, no effect of intrauterine growth was found on cognition and only postnatal head growth was associated with cognition. This effect was not shared by the co-twin.

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AIM: To underscore the importance of the pediatric neurological examination for the diagnosis, treatment and prognosis of nervous system disorders in children. For that, we reviewed the research carried out by our group in the past 40 years. DEVELOPMENT: Knowing the semiology of neurological development is essential for the neurological, psychological and motor follow-up of children. On their own, neuroimaging techniques are not sufficient to predict the long-term neurological and psychomotor consequences of perinatal events. On the other hand, the neurological examination is a sensitive method with good prognostic value, which facilitates a timely and appropriate treatment intervention. This observation has been confirmed by our research focused on the neurological examination, including the study of the developmental neurological examination in preschoolers, assessment of the psychological and neurological maturity in school age children, development of preterm-born school age children, limb-trunk coordination in premature newborns and their development, relationship between higher brain function, learning to read and write and improving the diagnosis of attention deficit/hyperactivity disorder in school children, neurological disorders in newborns, birth trauma, jaw opening reflex to appendicular compression, parachute and lateral propping reactions in newborns, neurological and psychomotor development at 6 months of corrected age in premature babies with neonatal crises and/or intracranial hemorrhage, and neurological examination in healthy newborns. CONCLUSIONS: The neuropediatrician must be aware of the importance of a comprehensive neurological history and consistent semiology to be able to request and correctly evaluate the results of ancillary tests, and thus make adequate treatment decisions.

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INTRODUCTION: Ischaemic stroke (IS) in childhood and adolescence is a condition that has received little attention from researchers and presents a multifactorial aetiology. In recent decades the rates of incidence seem to have risen, but underdiagnosis is still commonplace. It may appear as the first symptom of systemic disease in childhood, with the resulting devastating effects. Prothrombotic disorders represent important causal factors of ischaemic attacks in childhood. AIMS: The aims of this study were to identify the factors associated to IS in infancy and adolescence, as well as to establish the causation and to determine the abnormalities in the coagulation proteins of the patients that were studied. PATIENTS AND METHODS: A total of 46 patients diagnosed with IS, between 0 and 18 years of age, were included in the study over the period between March 2002 and September 2003. A number of lab tests were carried out, including analysis of coagulation proteins and echocardiograms. RESULTS: Neonatal IS was found in almost a third of the cases and practically half the sample had some disease prior to the ischaemic event. In all, 20% of the patients showed no IS-associated disorders. The most frequent clinical presenting symptoms were convulsions and hemiparesis. Anomalies were detected in proteins S and C in 22 and 17% of the sample, respectively. The middle cerebral artery was the most affected vascular region. CONCLUSIONS: IS-associated disorders were identified in most of the children and adolescents that were studied; moreover, prothrombotic risk factors are of great significance in the research into cases.

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INTRODUCTION: The prevalence of tuberculosis in developing countries, such as Brazil, remains high with important morbidity and mortality rates among children. Neurological complications are frequent and tuberculous meningo-encephalitis (TBM) is the most dreaded of them in infancy. CASE REPORT: Our case involves a 7-year-old white female patient who was previously in good health. Over a period of two weeks she suffered from high temperatures and vomiting and was given amoxicillin. She later suffered an attack of focal seizures. Electroencephalogram studies showed a temporary double focus and lesions in the left hemisphere. A cranial computerised tomography (CT) scan revealed a periventricular haemorrhage on the left side. The control CT (carried out 20 days later) showed a reduction in the haemorrhage and localised hypodensity. Owing to the suspected existence of an abscess, the patient was administered vancomycin. A new cranial CT scan (40 days after the first) showed gliosis alongside the basal nuclei with impregnation in the carotid trifurcation, which led us to suspect that we were dealing with a case of vasculitis or a granuloma. All the microbacterial cultures were negative and there was no history of contact with tuberculosis. The adenosine deaminase (ADA) value in the sample of cerebrospinal fluid (taken seven weeks after the first) was found to be 21.2 UI. Treatment was started with tuberculostatic compounds. Two weeks later the fever disappeared. The control CT scan showed decreased hypodensity and impregnation. The patient was discharged from hospital, with a slight monoparesis in the upper right limb. DISCUSSION: The presentation of a cerebrovascular disease within a context of TBM, like the case reported here, is relatively rare in the literature. We concluded that the uncommon initial symptoms of TBM, associated with the negative cultures, contributed to the delay in reaching a diagnosis. A cerebrovascular accident must be included in the clinical picture of TBM and this disease has to be taken into account when dealing with a case of cerebrovascular accident.

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AIMS: The aim of this study is to demonstrate the incidence of spastic tetraparesis (ST) in meningitis patients in the paediatric ICU, together with the associated variables, and establish comparisons with the existing literature. PATIENTS AND METHODS: We reviewed the medical records of patients who presented symptoms of meningitis and required hospital treatment in the Paediatric ICU at the Hospital de Clínicas de Porto Alegre, between January 1985 and June 2001. In addition to the diagnosis of meningitis and the incidence of ST as a complication, we also examined the aetiological agent, sex, age at the moment of hospital admittance, length of time spent in hospital and treatment given in each case. RESULTS AND DISCUSSION. An incidence of 15.1% was found for cerebral palsy in the 112 cases of bacterial meningitis that were followed up clinically. In the patients with ST, the time spent in hospital was longer, and the frequency of seizures, intracranial hypertension and the protein concentration levels in CSF were higher (p<0.05).

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The aim of this study was to assess the influence of biological markers of infection and antiretroviral therapy on the survival rate and quality of life in children with vertically-acquired HIV infection. This retrospective study was performed between August and October 2000. Outcome measures were presence of neurological disease, CD4 cell count, cranial computerized tomography (CT), electroencephalogram (EEG), use of antiretroviral agents, and mortality. The presence of neurological disease and of pathological findings in cranial computed tomography, and the lack of biological monitoring are associated with poor prognosis. Follow-up of this population should continue to allow long-term assessment of the social and biological impact of vertically-transmitted HIV.

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INTRODUCTION: It is necessary to differentiate neurological evaluation in the different stages of development, which include the premature newborn infant (PNI), the full term newborn, the unweaned baby, the child and the teenager. Several studies have shown the importance of using the corrected age when exploring the psychomotor development of premature babies. CASUISTICS AND METHOD: The population we studied was made up of a cohort of PNI who were born in the Hospital de Cl nicas de Porto Alegre and were monitored until they reached the age of 12 months. Motricity, sociability and speech were all considered. RESULTS AND CONCLUSIONS: It was possible to establish the frameworks of neurological development at the corrected ages of 3, 6, 9 and 12 months. The development of static balance was the only item among the motor aspects that did not agree with what was to be expected for the corrected age. The PNIs development was uniform, with regard to the perceptive and language functions for each corrected age. Such results reinforce the importance of studies like the one we present in this paper, since it is a period that can provide us with information that is useful for the early diagnosis of development disorders. It is also the best time to indicate psychomotor and affective stimulation, if we bear in mind the importance of the brain s plasticity during the first year of life.

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OBJECTIVE: To investigate the neurological performance of elementary school students from the city of Porto Alegre, state of Rio Grande do Sul, Brazil, in order to assess the association of neurological development and nutritional status. METHODS: We carried out an observational, analytical, and crosssectional study on a random and proportional population sample selected out of all first-grade students (n=35,521) in the city of Porto Alegre for a total of 484 children, out of which 64.7% were enrolled in state public schools, 11.9% in city public schools, and 23.4% in private schools. Our sample size allowed for a precision of -/+ 3% (95% confidence interval) for an estimated prevalence of 10% of cortical dysfunction. Children were submitted to individual examinations at the school. We collected data regarding sex, age, color of skin, nutritional status, and school of origin. An informed consent was obtained from the State and City Departments of Education and from the principals of the private schools. Statistical analysis was carried out using the chi-square test and ANOVA. RESULTS: From 11.4% to 38.2% of children presented ENE results lower than expected according to their age. The most affected factors were sensory activity and gnosia (38.2%), and the least affected factor was motor persistence (11.4%). There were no statistically significant differences between boys and girls. We observed an association of children with low height-for-age and weight-for-age and cortical dysfunction. CONCLUSIONS: Chronic malnutrition is a risk factor for brain function performance.

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OBJECTIVE: To report a case of Devic disease, emphasizing its diagnosis, in addition to reviewing the medical literature. DESCRIPTION: Male, six-year-old patient suddenly developed weakness in lower limbs, with resolution during hospital stay. However, as the weakness disappeared, loss of vision occurred. The symptoms were reverted after the use of prednisone. COMMENTS: The diagnostic and therapeutic approach was similar to that used in other cases reported by different reference centers. In other words, clinical diagnosis and prednisone therapy were used, with the complete improvement of symptoms. However, there is still some controversy surrounding its etiology and relationship with other demyelinating diseases, such as multiple sclerosis.