Journal of Pediatric Neurology - Volume 11, issue 1
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Journal of Pediatric Neurology is an English multidisciplinary peer-reviewed medical journal publishing articles in the fields of child neurology, pediatric neurosurgery, pediatric neuroradiology, child psychiatry and pediatric neuroscience.
Journal of Pediatric Neurology encourages submissions from authors throughout the world. The following articles will be considered for publication: editorials, original and review articles, rapid communications, case reports, letters to the editor and book reviews. The aim of the journal is to share and disseminate knowledge between all disciplines that work in the field of pediatric neurology.
Abstract: This study was aimed at examining possible correlation of psychosocial adversities with depression in mothers of children with cerebral palsy (CP) in Nigeria. The cross-sectional survey involved 45 consenting mothers of children with CP attending physiotherapy clinics of the University College Hospital, Ibadan, the Federal Medical Center and King Fahd Ibn Abdul-Aziz Women and Children Hospital Gusau, Nigeria. The psychosocial adversities scale (PAS) was used to assess psychosocial adversity while depression was…measured with the patient health questionnaire depression scale. The mean age of the mothers was 32.0 ± 5.0 yr and that of their children was 2.4 ± 1.5 yr. Spearman's rank order correlation showed a significant positive correlation between PAS and patient health questionnaire depression scale scores (r = 0.4; P = 0.006). Significant associations (P < 0.001) were found between depression and each item on the PAS, i.e. separated household, problem with extended family, lack of confidants, feeling of loneliness and isolation of mother. Logistic regression analysis indicated negligible risk of depression for mothers with low educational status (odds ratio = 0.4; 95% confidence interval = 0.08–1.1; P = 0.08). The depression risk was more than fourteen-fold in mothers whose husbands earned low incomes (odds ratio = 14.6; 95% confidence interval = 2.6–82.1 P = 0.002). Psychosocial adversities are significantly associated with depression in mothers of children with CP. Poor marital relationships (separated household and problem with extended family) and inadequate social interaction (feeling of loneliness and lack of confidants) were the most important psychosocial stressors associated with depression among mothers of children with CP in Nigeria.
Abstract: Ischemic stroke is infrequent in childhood. Etiological factors depend on epidemiological context. The purpose of this study is to determine risk factors, clinical and radiological features and outcome of arterial ischemic stroke in a cohort of Senegalese infants. We carried out a retrospective study of medical data of children hospitalized with arterial ischemic stroke in the neurological department of Fann teaching hospital and at Children's Hospital Albert Royer, from July 2003 to July 2011. Forty-eight…cases were included in this study with ages ranging from 2 months to 18 yr, with a female/male ratio of 0.71. Mean age at the time of occurrence stroke was 89.37 mo. The most common symptoms were hemiparesis (93.75%), motor partial seizures (24.44%), and Broca's aphasia (33.3%). The middle cerebral artery was mostly affected (87.5%). Risk factors were predominantly sickle cell disease, anemia, embolic heart disease, meningoencephalitis and head trauma. 8.33% of patients died. After discharge, 16.66% of patients were lost follow-up and 62.5% of the total cohort had neurological impairments. Treatment was essentially symptomatic and secondary prevention was provided by treatment with anticoagulants or anti-platelets agents depending on the etiology of ischemic stroke.
Abstract: The phenotypic severity of migraine has rarely been the subject of genetic epidemiological studies. In this study, we conducted a cross sectional survey of high school students using a validated questionnaire which covered the diagnostic features of migraine as specified by the International Classification of Headache Disorders, second edition. The phenotypic severity was assessed via Headache Impact Test-6 (HIT-6). We documented the family history of recurrent headaches in the parents and correlated it with a…diagnosis of migraine in the offspring. The participants included 272 students with mean age of 16.45 yr. The diagnosis of migraine in the participants was ascertained according to the International Classification of Headache Disorders, second edition criteria. When one of the parents suffered with recurrent headaches, the odds ratio for developing migraine in the subjects was only modestly increased (1.68). When both parents were affected, the odds ratio for migraine increased to 2.11. Logistic regression analysis with chi-square test of homogeneity of odds indicated a significant association with the students' risk of developing migraine and history of recurrent headaches in both parents (P < 0.02). Moreover, having two affected parents was associated with a lower age of onset (Chi-square, P < 0.04) and higher HIT-6 scores (t-test, P < 0.02) in the subjects. In conclusion, having two parents with recurrent headaches doubled the odds ratio for developing migraine in the offspring and was also associated with increased headache disability as measured by HIT-6 and a younger age of onset of migraines. We propose that assessing the clinical severity may represent a novel approach in studying genetic epidemiology of migraine.
Abstract: Cerebral palsy (CP) and epilepsy are the two most common chronic neurological diseases encountered by pediatric neurologists in Nigeria. Though epilepsy is commonly encountered among children with CP, there are very few studies on the prevalence of epilepsy among Nigerian children with CP and factors that are associated with this. This study was undertaken to determine the prevalence of epilepsy among children with CP and elucidate the factors that influences this. It was a retrospective analysis…of the case files of consecutive children that presented at the pediatric neurology unit of university of Nigeria teaching hospital, Enugu with a diagnosis of CP from 1st January 2007 to 31st December 2009. CP occurred in 20.8% of the children that presented at the pediatric neurology clinic. Spastic quadriplegic CP (55.5%) was the predominant type of CP encountered and the common causes were severe birth asphyxia (48.2%) and neonatal jaundice (20.1%). Epilepsy was observed in 37.8% of the children with CP. The common types of epileptic seizures observed were generalized tonic clonic seizures (38.7%), complex partial seizures (19.4%) and mixed epilepsy (19.4%). Infantile spasms and mixed epilepsy were observed predominantly among children with quadriplegic CP while those with hemiplegic CP almost exclusively presented with partial seizures (P = 0.01). We conclude that epilepsy is common among children with CP and severe seizure types like infantile spasm and mixed epilepsies are more common among quadriplegic CP.
Abstract: The objective of this study is to compare the prevalence and nature of cerebral palsy (CP) in a diagnosed cohort of individuals with Asperger's syndrome (AS) with general population data. We performed a nationwide, retrospective follow-up study of CP in all people who were born in Denmark during the period January 1, 1980 through June 29, 2006 and registered in the Danish Psychiatric Central Register with AS on February 7, 2011. All 4180 identified patients with…AS (3431 males and 749 females) were screened through the nationwide Danish National Hospital Register with respect to CP. Mean age at the end of the observation period was 18.1 yr (range 4–31 yr). Of the 4180 individuals with AS, 27 (0.65%) were registered with at least one CP diagnosis in the Danish National Hospital Register, which is significantly increased (P < 0.0001; odds ratio = 3.9) relative to the general population of Eastern Denmark, where an estimate is 0.17%. These population data lend support to the assumption that the risk of CP is increased in people with AS. Recognition of co-occurring disorders may provide insight into etiology and treatment needs.
Abstract: We report a case of a child presenting with sub-acute cerebellar ataxia that was associated with anti- N-methyl-D- aspartate (NMDA) receptor antibodies who dramatically responded to early aggressive immunomodulating therapy but not to conventional therapy. A three-year-old boy with history of prematurity and speech delays presented with subacute onset ataxia followed by progression to choreoathetosis, dysphagia, oro-facial dyskinesia, insomnia, aggressive behavior and loss of speech. An extensive work up for causes of…ataxia and occult malignancy was negative except for presence of oligoclonal bands and anti-NMDA receptor antibodies in the cerebrospinal fluid. The patient did not improve despite treatment with steroids and intravenous immunoglobulin. His first improvement occurred within 48 hr of rituximab infusion and with continued rituximab he returned to his neurological baseline. This anti-NMDA receptor encephalitis case presented as cerebellar ataxia refractory to conventional treatment and responded to rituximab.
Abstract: Moyamoya disease is a progressive vascular disease associated with steno-occlusion of the terminal portions of the internal carotid arteries and with several congenital and acquired conditions, including ischemic stroke in young children. This case report describes the discovery of an unusual association between moyamoya disease and type 1 diabetes mellitus in a 9-year-old child presenting with stroke-associated diabetic ketoacidosis. Discovery of this case highlights the importance of considering stroke as well as…cerebral edema, the more likely etiology, in the differential diagnosis of neurological deterioration in children with diabetic ketoacidosis, as well as considering moyamoya syndrome in the diagnosis of diabetic children presenting with stroke.
Abstract: Congenital mirror movement disorder is a rare presentation to a pediatric neurologist. In literature, only a few conditions are known to be associated with it. We describe a child who presented with the only complaint of imitation movements in contra-lateral upper limb and diagnosed to have nodular heterotopias and partial block cervical vertebrae.
Abstract: Sturge-Weber syndrome is a rare neurocutaneous disorder. Coexistence of facial nevus with epilepsy often suggests the diagnosis of Sturge-Weber syndrome. However, the diagnosis becomes more difficult when there is no facial nevus. Radiologic examinations are often used for diagnosis and management. Especially in cases without skin findings, the radiological examinations with typical findings become more important. In this paper, we report case of a 12-year-old girl who was followed with the diagnosis of epilepsy since the…age of two years, had complaints of weakness of the left arm and left leg without skin findings, and was diagnosed with Sturge-Weber syndrome after radiological examinations.
Abstract: Acute lymphoblastic leukemia is the most common malignancy in childhood. We present a 7-year-old boy with facial and hypoglossal nerve palsies as presenting features of acute lymphoblastic leukemia, which was suspected when magnetic resonance imaging demonstrated infiltrations of the brain, and was confirmed by bone marrow biopsy.
Abstract: Hyperglycemia is a common complication of extremely low birth weight infants (ELBW) which may have an impact upon their morbidity and mortality. Hyperglycemia in ELBW can occurred as result of many factors. We report a rare case of hyperglycemia in an ELBW infant after administration of a carbonic anhydrase inhibitor (acetazolamide), used for temporary management of posthemorrhagic hydrocephalus, our case was seen in one of the private hospital at Dammam city, Saudi Arabia.
Abstract: Benign enlargement of the subarachnoid space (BESS) is a common incidental finding on neuroimaging in infants. We report a case of BESS, who developed subdural hematoma and raised intracranial pressure following minor trauma. This case report highlights the fact that BESS may not be so benign after all and protective measures should be taken in all infants found to have BESS.
Keywords: Benign enlargement of subarachnoid space, subdural hematoma, intracranial hypertension
Abstract: Alpha-thalassemia mental retardation syndrome is an X-linked mental retardation (MR) syndrome characterized by a recognizable facial appearance, infantile hypotonia and cryptorchidism. Although the presence of alpha-thalassemia facilitates the diagnosis, its absence does not exclude the diagnosis of this rare syndrome. We describe two siblings who presented with facial dysmorphism, MR and a four-generation pedigree that revealed an X-linked recessive inheritance pattern. Their red blood cell indices were within the normal range; however,…hemoglobin H inclusions were detected following cresyl blue staining on their peripheral blood film. Mutational analysis revealed a point mutation C7156T that is predicted to have caused a premature termination within the alpha-thalassemia MR syndrome gene in both siblings. Confirmation of this mutation has facilitated the process of genetic counseling, carrier testing and prenatal diagnosis amongst female relatives in this family.
Abstract: A 9-year-old boy presented with fever, ptosis of the right eye and diplopia. Computerized tomography scan shows midbrain tuberculoma. After receiving antitubercular therapy function of oculomotor nerve became normal. Midbrain tuberculoma rarely presents as isolated oculomotor nerve palsy.