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Headache in children with brain tumors
No full textTo study the criteria for early differential diagnosis between migraine and headache due to brain tumors, we analyzed the symptoms and signs of two groups of children. The first group consisted of 67 children in whom a brain tumor had been diagnosed. The second group was composed of 600 children who had been diagnosed as migraine cases. Among the features of headache that are considered to be alarming symptoms of a brain tumor, the following were found to indicate a brain tumor with the greatest sensitivity: nocturnal headache or headache present on arising, both associated with vomiting, and increased frequency of headache. Nocturnal headache or headache present on arising, associated with vomiting, and/or progressive neurological symptoms or signs occurred in 65 of 67 children with brain tumor within 2 months of the onset of their headaches and in all 67 within 6 months
Brain tumors in childhood. Clinical aspects
No full textThe analysis of 76 case histories of children suffering from brain tumor revealed a majority in preschool age. The diagnosis at admission to the hospital was correct in 2/3 of the cases. The main causes for admission among unclear cases were headache, a history of head trauma, and epilepsy. An evaluation is made of the diagnostic value of symptoms, neurological signs, and of auxiliary investigations
Diagnostic approach in children with severely retarded psychomotor development of unknown origin
No full textIn infants and children with severe motor and/or mental retardation combined with a loss of acquired skills or with characteristic signs, such as e.g. a cherry red spot in the fundus, it is easy to suspect the presence of a hereditary metabolic disorder and to undertake the appropriate investigations. The diagnostic approach is, however, more difficult in retarded children with an uncertain developmental stillstand. Our goal was to devise strategies of how to deal with these patients from a diagnostic point of view. We retrospectively studied 77 children affected by severe developmental lag of unknown origin and without any clear signs of improvement or regression. A diagnosis of a hereditary metabolic disorder could be established in 12 of these children. In 5 other children a chromosomal abnormality or a structural abnormality of cerebral development was detected. Sixty children remained without any aetiological or pathogenetic diagnosis; 55 of them could be reexamined clinically after one year, and 32 of these showed then a clear improvement of their mental and/or motor performance. From the individual analysis of the 77 patients and from literature we conclude that if a child presents multiple minor malformations, investigations should concentrate on chromosomal aberrations and on possible structural brain abnormalities. Metabolic studies should be performed if the same disease already occurs in the family and where characteristic signs are present. In children without such signs the psychomotor development should be reevaluated after one year. If after this year there is an improvement, there is no reason for starting extensive investigation
Obstetrical lesions of the brachial plexus. Natural history in 34 personal cases
No full text34 subjects with 36 obstetrical paralysis of the brachial plexus were studied. The diagnosis was made immediately after birth in the great majority. 5 pareses of the lower plexus, however, were only recognized later. All subjects were first seen by us under the age of 13 years, 25 during the first year of life. At follow-up the age of the 34 subjects varied between 3 and 24 years. 32 patients had undergone daily physiotherapy, in 5 electrotherapy had also been applied. There was no correlation between these treatments and the outcome. Of the 20 cases of paresis of the lower plexus 3 were severely handicapped after the age of 3. This was the case for 9 of the 12 patients with total paresis. Everyday activities of these patients are influenced by the motor deficit. Even subjects with relatively serious sequelae apparently enjoy an almost normal life and have a good self-image. A significant improvement generally occurred as early as the first 3 years of life
Complicated migraine (migraine accompagnée) in children. Clinical characteristics and course in 40 personal cases
No full textForty cases of complicated migraine (c.m.) were analysed. The onset was before the age of 16 years, in the majority, however, after the 10th year. In 20 patients the first crisis of c.m. occurred in the absence of a previous history of migraine. 38 of the children had paresthesia during the crises, localized mostly to one hemisoma or a part thereof, in 3 bilateral from the beginning. In the majority of these patients the same hemisoma was always affected, the upper limb almost always. The preferred localisation of paresthesia in the face were the mouth and/or the tongue. A progression of paresthesia with a "march" of several minutes duration was frequent. In 5 children a paresis occurred, mostly at the upper part of one hemisoma, in another 4 children hemiplegia was present. In several cases signs of brainstem lesion occurred. Headache was mostly localized on the opposite side to the neurological signs. Vomiting and scotoma were frequent. In EEG done during the periods of crisis anomalies were demonstrated in the majority of our patients with a predominance of diffuse or focal slowing. In our patients there was a spontaneous tendency for c.m. to disappear upon reaching adult age. None of our 25 patients who had a neurological examination at the last check-up has shown residual deficits
Hereditary motor sensory neuropathies in childhood
No full textClinical data on 24 patients with hereditary motor sensory neuropathies, with onset in the paediatric period, and of their relatives, is reported. Electrophysiological studies were done in all patients and in 15 relatives. The patients were divided into two groups (Types I and II) and their hereditary trait was determined. In 11 patients a sural nerve biopsy was performed and revealed different patterns of histological alterations. The nerve biopsy always confirmed the value of conduction velocity in distinguishing between Types I and II. A genetic discordance was observed, both in regard to the phenotype and the conduction velocity, and there was increased slowing of the conduction velocity as individuals grew older. Thus the classification of these disorders in childhood can be particularly difficult. The rôle of sural nerve biopsy is discussed
Late infantile metachromatic leucodystrophy (MLD). Clinical and diagnostic evaluation in a typical case
No full textA typical case of late infantile MLD is presented with all available clinical, morphological and biochemical results. The diagnostical value of the different parameters is evaluated and the pathogenesis of the disorder discussed. In spite of successful experimental enzyme substitution in cultured MLD fibroblasts with restitution of function by added Arylsulfatase, the therapeutic possibilities for the fatal disease in the patients are extremely limited
Does migraine-related stroke occur in childhood?
No full textThis report concerns seven children who had at least one episode of infarct, possibly during an attack of migraine. They fulfilled the following criteria: presence of acute neurological deficit associated with headache or other symptoms characteristic of migraine attacks; a history of migraine; evidence of infarct on CT scan; and no other evident cause of the stroke. CT showed that the area of infarction was in the distribution of the posterior cerebral artery in three cases. Four of the children have been followed for at least 23 months and none has severe residual deficit. An aetiological relationship between migraine and stroke could not be demonstrated. However, epidemiological data suggest that childhood migraine can be a contributory risk-factor for strokes
Benign migraine-like syndrome with CSF pleocytosis in children
No full textFour children with symptoms consistent with complicated migraine had CSF pleocytosis, in three cases lymphocytic and in the fourth polymorphonuclear. In one case the CSF abnormality was found during two separate attacks of complicated migraine. On the basis of the 23 cases reported in the literature and these four personal cases, the authors conclude that, as a rule, pleocytosis is a secondary phenomenon of an attack of complicated migraine. However, in exceptional cases an infectious disease might produce both a migraine attack and CSF pleocytosis
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