Journal of Pediatric Neuroradiology - Volume 1, issue 2
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Journal of Pediatric Neuroradiology is an English multidisciplinary peer-reviewed international journal providing a forum for the publication of papers on all topics related to child neuroradiology including diagnostic, functional and therapeutic imaging of the brain, head, neck, spine; congenital central nervous system malformations; pediatric ophthalmologic and otorhinolaryngologic imaging.
Journal of Pediatric Neuroradiology provides an in-depth update on new subjects, and current comprehensive coverage of the latest techniques in neuroradiological diagnosis and treatment in childhood.
Journal of Pediatric Neuroradiology encourages submissions from all authors throughout the world.
The following articles will be considered for publication: editorials, original and review articles, short report, 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 child neuroradiology.
Abstract: Hydrocephalus can be defined as ventriculomegaly secondary to excessive increment of cerebrospinal fluid in ventricular system. The diagnosis of hydrocephalus is not a challenge presently, but the exact definition of this entity and its etiology is often difficult. Early detection of the etiology of hydrocephalus is vital for accurate and early treatment. In childhood, obstructive hydrocephalus is the most common type of hydrocephalus. Magnetic resonance imaging (MRI) is the radiological method providing the maximal clinically useful data needed for reaching the precise diagnosis and initiating the correct treatment. In this review, we discuss the role of MRI in the evaluation…of pediatric obstructive hydrocephalus patients based on new techniques and recent literature.
Abstract: Pediatric cerebellar tumors constitute a heterogeneous group of central nervous system neoplasms with very different imaging characteristic, spread patterns, and outcomes. At one end of the spectrum are the pilocytic astroctyomas which have very good prognosis following complete resection. At the other end are the medulloblastomas and atypical teratoid/rhabdoid tumors with relatively poor outcomes. Familiarity with imaging characteristics of these common neoplasms is important in performing the role of the pediatric neuroradiologist. Magnetic resonance spectroscopy and diffusion weighted imaging play important adjuncts to conventional imaging in the diagnosis and follow-up of these tumors.
Abstract: Magnetic resonance angiography (MRA) studies have shown that cerebral vessels in preterm infants at term age are less tortuous than in term-born infants. The reasons for this are not clear. The aim of this study was to investigate this distinct vascular morphology by comparing contemporaneous MRA with Doppler ultrasound measurements of cerebral blood flow velocity at term age. Sixteen preterm and five term-born infants without overt cerebral pathology underwent Doppler ultrasound measurements of cerebral blood flow velocities and MRA around term equivalent age. Peak systolic, end-diastolic, average mean of the maximum and mean velocity and resistance index were measured on…the anterior and middle cerebral arteries. Vessel tortuosity was measured on MRA images. The resistance index was significantly higher in preterm than in term-born infants; this related to the peak systolic velocities tending to be higher and end-diastolic velocities being significantly lower in preterm infants though average mean of the maximum and mean velocities were not different. No significant correlations were found between any of the cerebral blood flow velocity parameters and vessel tortuosity. These differences suggest that cerebrovascular resistance is higher in preterm infants. We postulate that cerebrovascular resistance during the third trimester contributes to vascular development and morphology and that altered resistance may contribute to the suboptimal development of the preterm infant brain.
Abstract: Arachnoid cysts (ACs) are commonly encountered fluid collections in the central nervous system. Most cranial ACs are found incidentally and can be managed conservatively. This review presents and discusses clinical findings, diagnostic methods and management of intracranial ACs in 32 patients who were surgically treated in our clinic. The study included 23 male and nine female patients. Most of them were pediatric cases (77%) at the time of surgery. All diagnoses were confirmed on neuroradological examination. Twenty-six of the cysts were supratentorial (81.2%). The most common symptoms at presentation were seizures (50%), headache (37.5%), weakness (23%), and hydrocephalus (9%). Cystoperitoneal…shunt placement, craniotomy, or endoscopic fenestration, are the surgical methods. Long-term outcome was favorable in most of these patients. Untreated, ACs may cause permanent severe neurological damage due to the progressive expansion of the cyst or hemorrhage. However, with surgical treatment most individuals with ACs do well.
Keywords: Arachnoid cyst, cranial, epilepsy, surgery
Abstract: Pediatric stroke is particularly challenging because of its variable presentation and relative rarity. Diagnosis of pediatric stroke is often delayed while other diagnoses are considered, unfortunately leading to a loss of therapeutic opportunity. Recent research advances in adult stroke such as multimodal imaging and a clinical trial showing benefits in extending the therapeutic window for thrombolytics are likely to have important implications in pediatric stroke. We describe the case of a 13-year-old boy presenting with acute stroke where multimodal magnetic resonance imaging with perfusion and permeability images allowed safe treatment with thrombolysis outside the standard treatment time window.
Keywords: Multimodal MRI, thrombolysis, stroke, children
Abstract: Menkes disease, an inherited disorder of copper transport, shows a spectrum of different neuroradiological findings. Diffuse brain atrophy, deficient myelination, and subdural hematoma/hygroma were described. Anomalies of the cerebral arteries with elongation and tortuosity are known. We report the neuroradiological follow up of a patient suffering from Menkes disease confirmed by the identification of a deletion of ATP 7A gene. Ultrasound scanning at the age of two months demonstrated normal brain morphology. One month later, magnetic resonance imaging (MRI) showed vermian hypoplasia, brain atrophy and retarded myelination. Marked widening of cerebral venous sinuses in conventional angiography and in magnetic resonance…venography was detected and led to arterial cerebral angiography, which did not disclose an arteriovenous fistula. Despite parenteral copper therapy, on MRI follow up seven months later, extra-axial blood and hygroma were visible and the signs of cerebral atrophy and myelination deficit were more pronounced. In Menkes disease, neuroradiological anomalies can occur early and progress rapidly despite copper therapy. When evaluating magnetic resonance angiography results in neurodegenerative diseases, Menkes disease should be suspected not just when cerebral arterial anomalies are demonstrated. Widening of the cerebral venous sinuses might be caused by secondary to brain atrophy or involvement of the vein walls.
Abstract: Bacterial brain abscesses are a potentially catastrophic complication of neonatal care requiring prompt diagnosis and management to avoid neurologic sequelae. Enterobacter species are known to cause multifocal lobar abscesses in the neonatal brain similar to other gram negative facultative anaerobic rods such as Citrobacter species. A preterm neonate developed Enterobacter cloacae cerebral abscesses after 3 weeks in the neonatal intensive care unit. Brain magnetic resonance imaging (MRI) demonstrated large periventricular ring-enhancing cystic-appearing lesions with hypointense internal stranding present on gradient echo sequences. The abscesses were treated with neurosurgical drainage and a prolonged course of antibiotics. We present…the case details, radiologic findings including MRI features of Enterobacter cloacae abscesses and management of this difficult case.
Abstract: We present an unusual case of Janiceps asymmetros, a rare variant of the cephalothoracopagus type of conjoined twins. Incidence of cephalothoracopagus is 1 in 3 million births and 1 in 58 sets of conjoined twins. Only about 300 cases have been reported in the literature until date. Early intrapartum ultrasound diagnosis of Janiceps allows careful planning the mode of delivery and preoperative assessment for surgical separation of conjoined twins. Final outcome depends on state of conjoined organs and potential for successful separation of conjoined twins.
Abstract: Posterior reversible encephalopathy syndrome (PRES) (synonym: reversible posterior leukoencephalopathy syndrome, reversible posterior cerebral edema syndrome) is a neurotoxic state associated with sudden elevation in blood pressure. It presents initially with lethargy and somnolence but can also manifest as headache, confusion, hemianopsia, nausea vomiting, seizures, vision disturbance, paresis, and cortical blindness. Very often these features are short lived and are resolved both clinically and radiologically but occasionally this disease can progress to coma and other devastating permanent complications. Several etiological factors have been described in literature including hypertensive encephalopathy, preeclampsia, eclampsia, infection, immunosuppression, autoimmune diseases, cyclosporine toxicity, drug overdose, trauma with…aortic dissection, pheochromocytoma and Guillain-Barré syndrome (GBS). Particularly, very few cases have been reported in literature indicating GBS as a precipitating factor for PRES. Therefore, we present here a brief review of literature describing association between GBS and PRES along with detailed diagnostic and therapeutic description. This review suggests necessity for adequate clinical suspicion for PRES in GBS afflicted patient followed by prompt diagnostic and therapeutic intervention. Failure to treat promptly and adequately might lead to the catastrophic consequence both in terms of morbidity and mortality.