RESUMO
OBJECTIVE: To determine whether children with homozygous sickle cell anemia (SCD) who have silent infarcts on magnetic resonance imaging (MRI) of the brain are at increased risk for overt stroke. METHODS: We selected patients with homozygous SCD who (1) enrolled in the Cooperative Study of Sickle Cell Disease (CSSCD) before age 6 months, (2) had at least 1 study-mandated brain MRI at age 6 years or older, and (3) had no overt stroke before a first MRI. MRI results and clinical and laboratory parameters were tested as predictors of stroke. RESULTS: Among 248 eligible patients, mean age at first MRI was 8.3 +/- 1.9 years, and mean follow-up after baseline MRI was 5.2 +/- 2.2 years. Five (8.1%) of 62 patients with silent infarct had strokes compared with 1 (0.5%) of 186 patients without prior silent infarct; incidence per 100 patient-years of follow-up was increased 14-fold (1.45 per 100 patient-years vs 0.11 per 100 patient-years, P =.006). Of several clinical and laboratory parameters examined, silent infarct was the strongest independent predictor of stroke (hazard ratio = 7.2, P =.027). CONCLUSIONS: Silent infarct identified at age 6 years or older is associated with increased stroke risk.
Assuntos
Anemia Falciforme/complicações , Infarto do Miocárdio/complicações , Acidente Vascular Cerebral/etiologia , Criança , Humanos , Lactente , Imageamento por Ressonância Magnética , Infarto do Miocárdio/diagnóstico , Fatores de RiscoRESUMO
We report medullary injury during adenoidectomy in two children who received injections of local anesthetic agents into the operative bed. Initial manifestations included hemiparesis, nystagmus, and ataxia. Magnetic resonance imaging showed hemorrhagic, paramedian medullary lesions in both patients. The mechanism of injury is likely to be injection of fluid into the medulla.
Assuntos
Adenoidectomia/efeitos adversos , Anestésicos Locais/efeitos adversos , Tronco Encefálico/lesões , Injeções/efeitos adversos , Paresia/etiologia , Adenoidectomia/métodos , Ataxia/etiologia , Criança , Pré-Escolar , Epinefrina/administração & dosagem , Humanos , Lidocaína/administração & dosagem , Imageamento por Ressonância Magnética , Masculino , Nistagmo Patológico/etiologia , Medição de RiscoRESUMO
In a newborn infant with galactose-1-phosphate uridyltransferase deficiency and encephalopathy, brain magnetic resonance imaging revealed cytotoxic edema in white matter. Using in vivo proton magnetic resonance spectroscopy, we detected approximately 8 mmol galactitol per kilogram of brain tissue, an amount potentially relevant to the pathogenesis of brain edema.
Assuntos
Encefalopatias Metabólicas Congênitas/metabolismo , Encéfalo/metabolismo , Galactitol/farmacocinética , Galactosemias/metabolismo , Humanos , Recém-Nascido , Espectroscopia de Ressonância Magnética , MasculinoRESUMO
The Na+/myo-inositol cotransporter (SLC5A3) gene, located on the long arm of human chromosome 21, may play a key role in osmoregulation including the regulation of levels of the "idiogenic osmole," myo-inositol, in brain cells. To determine whether the levels of myo-inositol are increased in the basal ganglia of children with Down syndrome, we performed in vivo brain hydrogen 1-nuclear magnetic resonance or 1H-magnetic resonance spectroscopy and measured plasma osmolality in a cohort of children with trisomy 21. Myo-inositol is elevated in the corpus striatum of infants and children with Down syndrome, even in the absence of hypertonic stress.
Assuntos
Gânglios da Base/metabolismo , Síndrome de Down/sangue , Inositol/sangue , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Espectroscopia de Ressonância Magnética , Masculino , Concentração OsmolarRESUMO
Hemorrhagic shock and encephalopathy syndrome is an acute childhood illness that involves the rapid onset of multisystem failure, including central nervous system, renal, cardiovascular, hepatic, and hematologic dysfunction, and often leads to death or serious neurologic damage. We report the first case of a child with hemorrhagic shock and encephalopathy in which magnetic resonance imaging was used to define the cortical hemorrhagic involvement.
Assuntos
Encéfalo/patologia , Hemorragia Cerebral/patologia , Infarto Cerebral/patologia , Encefalopatias/complicações , Encefalopatias/fisiopatologia , Hemorragia Cerebral/complicações , Infarto Cerebral/complicações , Proteção da Criança , Hospitalização , Humanos , Lactente , Tempo de Internação , Imageamento por Ressonância Magnética , MasculinoRESUMO
We evaluated 37 patients with hemifacial spasm and 16 age-matched control patients with other neurological disorders using magnetic resonance (MR) imaging, MR angiography, and MR tomographic angiography. MR tomographic angiography is a new technique using computer reconstruction of MR angiographic images to create coronal angiotomes that display tissue and arterial structures on the same image. Twenty-four of 37 (64.9%) patients with hemifacial spasm had ipsilateral vascular compression of cranial nerve VII or the pons noted by this technique, whereas only 1 of 16 (6.3%) control patients had compression. MR imaging and MR angiography were less sensitive and less specific in evaluating for vascular compression. This study supports vascular compression of cranial nerve VII or the pons as a cause of hemifacial spasm, and demonstrates MR tomographic angiography's value as an excellent, noninvasive technique to demonstrate the compression.
Assuntos
Angiografia , Tronco Encefálico/patologia , Músculos Faciais , Nervo Facial , Processamento de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética , Síndromes de Compressão Nervosa/diagnóstico , Espasmo/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artéria Basilar/diagnóstico por imagem , Encefalopatias/diagnóstico , Cerebelo/irrigação sanguínea , Feminino , Lateralidade Funcional , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/complicações , Artéria Vertebral/diagnóstico por imagemRESUMO
Localized water-suppressed 1H magnetic resonance spectroscopy was performed in an 11-month-old infant with Leigh syndrome. Spectra obtained from the basal ganglia, occipital cortex, and brainstem showed elevations in lactate, which were most pronounced in regions where abnormalities were seen with routine T2-weighted magnetic resonance imaging. This approach has allowed us to examine metabolism in brain tissue directly and noninvasively, and may provide a sensitive means for evaluating metabolic disease and the response to therapy in the brain.
Assuntos
Encéfalo/metabolismo , Lactatos/metabolismo , Doença de Leigh/metabolismo , Encéfalo/patologia , Feminino , Humanos , Hidrogênio , Lactente , Ácido Láctico , Doença de Leigh/diagnóstico , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância MagnéticaRESUMO
We evaluated 17 children with primary intracranial neoplasms for subarachnoid metastatic disease (SAMD) using myelography with computed tomographic follow-up (Myelo + CT) and cerebrospinal fluid (CSF) histopathologic examination, as well as magnetic resonance imaging with gadolinium DTPA (MRI + Gd), between December 1988 and December 1989. There were 12 boys, and the median age was 5.7 years (range, 0.8 to 21.8 years). Tumor histology included 8 primitive neuroectodermal tumors (PNETs), 3 ependymomas, 2 low-grade astrocytomas, 1 anaplastic astrocytoma, 1 glioblastoma multiforme, 1 atypical rhabdoid tumor, and 1 malignant fibrous histiocytoma. Thirteen tumors originated in the posterior fossa, 2 were supratentorial, and 2 were in the spinal cord. The median interval between the 2 diagnostic tests was 2 days. MRI + Gd was positive in 11 (65%), Myelo + CT in 8 (47%), and CSF in 5 (29%) cases. MRI + Gd was superior in delineating spinal cord nodules and "sugar coating" whereas Myelo + CT more readily revealed nerve root sleeve filling defects. There was no case in which Myelo + CT was positive that MRI + Gd did not reveal SAMD. MRI + Gd is a safe, noninvasive test that should be used as the initial imaging modality for the presence of SAMD.
Assuntos
Gadolínio , Imageamento por Ressonância Magnética , Mielografia , Neoplasias da Medula Espinal/diagnóstico , Espaço Subaracnóideo , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/secundárioRESUMO
The complex anatomy and multiple functions of the structures involved in the sella, suprasellar, and parasellar spaces present a challenge for the imager in identifying an etiology when symptoms are present. Computed tomography, magnetic resonance imaging, and arteriography all play roles depending upon the localization of the process. In this area, as in others, care must be exercised, as nonneoplastic masses may mimic those that are neoplasms. Studies must be tailored to answering questions posed by the differential diagnosis.
Assuntos
Neoplasias Encefálicas/diagnóstico , Neoplasias Hipofisárias/diagnóstico , Neoplasias Encefálicas/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Neoplasias Hipofisárias/diagnóstico por imagem , Sela Túrcica/diagnóstico por imagem , Sela Túrcica/patologia , Tomografia Computadorizada por Raios XRESUMO
The association between neurofibromatosis and visual pathway gliomas is well documented. The introduction of computed tomography and magnetic resonance imaging has heralded a new era in the understanding of visual pathway gliomas. Both of these noninvasive neuroinvestigative techniques have demonstrated extensive abnormalities throughout the visual pathway in children with visual pathway gliomas, especially in those with neurofibromatosis. The clinical significance of these abnormal areas of brain, especially in asymptomatic patients, is unknown. In an attempt to clarify the incidence, natural history, and clinical course of patients with neurofibromatosis and visual pathway lesions, we reviewed our experience with 24 patients managed consecutively at Children's Hospital of Philadelphia over the past 12 years. The patients in this series were compared to 29 children with visual pathway gliomas without neurofibromatosis who were evaluated at our institution over the same period of time. Visual pathway gliomas in children with neurofibromatosis differ from those in children without neurofibromatosis. In general, lesions tended to be more extensive in patients with neurofibromatosis and the clinical course of these patients is more variable. Twelve of the 24 patients with neurofibromatosis in our series had symptoms of progressive disease at the time of diagnosis and underwent treatment with variable results. Twelve children with neurofibromatosis and visual pathway lesions had static lesions at the time of diagnosis and, to date, 3 have developed progressive disease. From our review we can make some recommendations concerning the management of children with neurofibromatosis and visual pathway gliomas, but many questions remain unanswered. Sequential follow-up of a large cohort of both asymptomatic and symptomatic children with neurofibromatosis and visual pathway lesions is needed to more definitively outline the best management approach for these patients.