Neuropediatrics
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Initial reporting and validation of the Camino miniaturised fibreoptic cerebral intraparenchymal pressure monitoring device has indicated that this tip transducing system (a) allows direct measurement of brain tissue pressure, (b) has a rapid response rate to intracranial changes and (c) correlates well with intraventricular pressure. However, there are no specific reports of this form of monitoring during non-traumatic coma in children, or any evaluation of change in clinical practice when compared with experience of other forms of invasive intracranial pressure monitoring. Over a 5-year-period (1985-1989) on the General Paediatric Intensive Care Unit, 74 children with presumed raised intracranial pressure complicating non-traumatic coma have had invasive intracranial pressure monitoring with a variety of devices. ⋯ In the whole series there were no cases of acute haemorrhage related to monitoring and only one patient developed infection and in this child an intraventricular catheter was used. The experience with the fibreoptic system has been favourable and the technique for insertion does not require additional expertise in comparison with standard subarachnoid screw pressure monitoring. Therefore in young children with raised intracranial pressure complicating non-traumatic coma, cerebral fibreoptic intraparenchymal pressure monitoring should be used in preference to standard subarachnoid screw pressure monitoring.(ABSTRACT TRUNCATED AT 250 WORDS)
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A child with intermittent upward deviation of the eyes starting at 9 months of age, compensating bending forward of the head, nystagmus on attempted downward gaze and a mild gait ataxia is described. The symptoms gradually disappeared between 3 and 4 years of age. Four cases with identical clinical findings have been initially described by Ouvrier in Australia (5) as "benign paroxysmal tonic upgaze of childhood". It is apparently a new syndrome.
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To evaluate the utility and safety of chronic extraoperative subdural EEG and functional localization studies in children compared to adults, we studied 61 patients each of whom had similar evaluations for epilepsy surgery, regardless of age. The 23 children and adolescents (3 to 18 years old) and the 38 adults (20 to 41 years old) each had several days and nights of extraoperative EEG from scalp and chronically-implanted subdural electrodes, and the same percentage of children and adults also had functional localization studies including cortical electrical stimulation. ⋯ The subdural technique was as effective and well-tolerated in children and adolescents as in adults. Other invasive EEG techniques have not yet been systematically compared between children and adults, but the subdural technique, at least, appears to be suitable for patients over a wide age range.
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Case Reports
Rubella myelitis and encephalitis in childhood. A report of two cases with magnetic resonance imaging.
Two children are described with postnatally acquired acute rubella which induced neurological disease. The first patient with restricted transverse myelitis (Th 11-12) was remarkable for the positive result obtained by the magnetic response (MR) technique of the spinal cord. ⋯ No abnormalities were noticed by MR five weeks after the clinical onset. The possible significance of MR imaging in virus-induced encephalomyelitis is discussed.
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Comparative Study
Respiratory pauses in very low risk prematurely born infants reaching normal term. A comparison to full-term newborns.
We studied the occurrence of greater than or equal to 2 sec. respiratory pauses (RP) in very low risk, normal prematurely born infants (less than or equal to 36 wks. of gestation), recorded when they reached 37-40 wks. conceptional age and compared the results with those of full-term (37-41 wks. of gestation) newborns. The influence of gestational age at birth (GA), postnatal age, sleep states, twin birth and gross body movements was tested. We recorded 2434 central RP and only one 4 sec. duration obstructive RP. ⋯ There were no significant differences between prematurely born twins and singletons. When they reached normal term, infants born before 35 wks. of gestation had more RP, compared to infants born at 35-36 wks. of gestation. About 12% of RP occurred after gross body movements.