Summary Background Multiple sclerosis (MS) diagnostic criteria incorporate MRI features that can be used to predict later diagnosis of MS in adults with acute CNS demyelination. To identify MRI ...predictors of a subsequent MS diagnosis in a paediatric population, we created a standardised scoring method and applied it to MRI scans from a national prospective incidence cohort of children with CNS demyelination. Methods Clinical and MRI examinations were done at the onset of acute CNS demyelination and every 3 months in the first year after that, and at the time of a second demyelinating attack. MS was diagnosed on the basis of clinical or MRI evidence of relapsing disease. Baseline MRI scans were assessed for the presence of 14 binary response parameters. Parameters were assessed with a multiple tetrachoric correlation matrix. Univariate analyses and multivariable Cox proportional hazards models were used to identify predictors of MS. Findings Between Sept 1, 2004, and June 30, 2010, 332 children and adolescents were assessed for eligibility. 1139 scans were available from 284 eligible participants who had been followed up for 3·9 (SD 1·7) years. 57 (20%) were diagnosed with MS after a median of 188 (IQR 144–337) days. Seven of 14 binary response parameters were retained. The presence of either one or more T1-weighted hypointense lesions (hazard ratio 20·6, 95% CI 5·46–78·0) or one or more periventricular lesions (3·34, 1·27–8·83) was associated with an increased likelihood of MS diagnosis (sensitivity 84%, specificity 93%, positive predictive value 76%, negative predictive value 96%). Risk for MS diagnosis was highest when both parameters were present (34·27, 16·69–70·38). Although the presence of contrast enhancement, cerebral white matter, intracallosal, and brainstem lesions was associated with MS in the univariate analyses, these parameters were not retained in the multivariable models. Interpretation Specific MRI parameters can be used to predict diagnosis of MS in children with incident demyelination of the CNS. The ability to promptly identify children with MS will enhance timely access to care and will be important for future clinical trials in paediatric MS. Funding Canadian Multiple Sclerosis Scientific Research Foundation.
Objective To assess the safety and efficacy of antithrombotic therapy (ATT) for secondary stroke prevention of childhood bacterial meningitis. Study design A retrospective study of cases of stroke ...associated with bacterial meningitis in 2 pediatric hospitals during a period of 15 years. Patients were included in the study if they were between 28 days and 18 years of age and had at least 2 serial neuroimaging studies during the acute phase of their illness. The safety of ATT was assessed by the presence or absence of intracranial hemorrhage. Efficacy was assessed by the failure in preventing stroke recurrence. Neurologic outcome was determined by the last documented Pediatric Stroke Outcome Measure score. Results Twenty-two cases of childhood bacterial meningitis complicated by stroke were identified. Six cases were treated with heparin after either initial or recurrent infarction. None of the cases receiving heparin had further recurrence. Aspirin (acetylsalicylic acid ASA) was started after the initial or after recurrent infarction in 10 cases. Four (40%) had infarctions on ASA; 3 of these patients subsequently received heparin. In the 14 cases in which no ATT was begun, 8 (57%) had further recurrence of infarction. None of the patients, whether receiving heparin or ASA, had intracranial hemorrhage. Conclusion In this small sample, heparin and ASA appeared to be safe in childhood bacterial meningitis complicated by stroke and may be effective in improving outcome. Heparin may be more effective than aspirin in preventing recurrent infarction.
Abstract Background Hypercapnic-challenge blood oxygen level–dependent magnetic resonance imaging cerebrovascular reactivity (CVR), measures the regional perfusion response to altered carbon dioxide. ...CVR correlates with the tissue-level microvascular dysfunction and ischemic risk. Among children with arterial ischemic stroke, transient cerebral arteriopathy (TCA) is a frequent, nonprogressive unilateral intracranial arteriopathy, which typically results in basal ganglia infarction and chronic cerebral artery stenosis. Therefore TCA provides a model for studying the consequences of chronic nonprogressive stenosis using CVR and intellectual outcome. We hypothesized that children with TCA and chronic nonprogressive intracranial artery stenosis have impaired CVR distal to the stenosis and associated cognitive impairment. Methods We studied children with a prior diagnosis of TCA as defined by infarction limited to the basal ganglia, internal capsule, or both; and significant (greater than 50% diameter) residual stenosis of the supraclinoid internal carotid artery, its proximal branches or both. All children had CVR, intellectual function, and infarct volumes quantified. Results We performed CVR studies in five children at mean 8.96 years (3.33 to 14.58 years) poststroke. Impaired CVR was limited to the infarct zone and adjacent white matter in most children. Intellectual function was broadly average in all but one subject. Conclusions In children with typical TCA, ipsilateral cortical CVR and intellectual function seem to be preserved despite persistent arterial stenosis in the majority. These findings suggest that chronic revascularization strategies in these children may not be indicated and require further exploration in a larger cohort of children.
Craniosynostosis is when cranial sutures fuse prematurely. It causes cosmetic deformity and may limit brain growth with more serious consequences, such as hydrocephalus. It may involve one or more ...sutures, may be syndromic, and is thought most likely to result from genetic causes. Specific sutural closures result in reproducible cranial appearances and head shapes. Three-dimensional computed tomography has become the standard for preoperative diagnosis to allow surgical planning as well as postsurgical assessment. Early diagnosis allows early surgical management, which improves outcome. Nonsyndromic and syndromic craniosynostoses are illustrated in this pictorial review.
Childhood central nervous system vasculitis Moharir, Mahendranath; Shroff, Manohar; Benseler, Susanne M
Neuroimaging clinics of North America,
05/2013, Volume:
23, Issue:
2
Journal Article
Peer reviewed
Inflammatory brain diseases in childhood are underrecognized and lead to devastating yet potentially reversible deficits. New-onset neurologic or psychiatric deficits in previously healthy children ...mandate an evaluation for an underlying inflammatory brain disease. Distinct disease entities, such as central nervous system (CNS) vasculitis, are now being increasingly reported in children. Clinical symptoms, initial laboratory test, and neuroimaging studies help to differentiate between different causes; however, more invasive tests, such as lumbar puncture, conventional angiography, and/or brain biopsy, are usually necessary before the start of treatment. This article focuses on childhood CNS vasculitis.
Diagnosing neuromyelitis optica Makhani, Naila; Bigi, Sandra; Banwell, Brenda ...
Neuroimaging clinics of North America,
05/2013, Volume:
23, Issue:
2
Journal Article
Peer reviewed
Neuromyelitis optica (NMO) is a severe inflammatory demyelinating disorder typically characterized by attacks of recurrent optic neuritis and transverse myelitis. Advances in magnetic resonance ...imaging techniques and the discovery of the relatively specific NMO IgG biomarker have led to improved diagnostic accuracy and greater recognition of the broad clinical spectrum of aquaporin 4-related autoimmunity. Brain lesions in NMO typically follow the distribution of aquaporin 4 expression and may be symptomatic. Prompt diagnosis of NMO and NMO spectrum disorders has important therapeutic implications given the high risk of recurrent attacks and consequent severe disability, especially in childhood-onset disease.
We present the case of a child affected with retinoblastoma and evolving optic nerve pathology detected by spectral domain optical coherence tomography (SD-OCT) before magnetic resonance imaging. At ...6 months of age, the patient was diagnosed with bilateral retinoblastoma, which was managed with systemic chemotherapy and focal therapy. Six months after the third and final cycle of systemic chemotherapy, the right optic disk clinically appeared progressively edematous, raising concerns of tumor infiltration of the optic nerve head. Images obtained via magnetic resonance imaging could not confirm the presence of a tumor at the optic nerve head, whereas findings on SD-OCT were suggestive of optic nerve head disease. Histopathologic findings after enucleation revealed viable tumor over the optic nerve head, supporting the OCT findings.
This article reviews the features that should prompt consideration of diseases that mimic acquired demyelinating syndromes and multiple sclerosis using vignettes to highlight unusual clinical and ...radiologic features. Cases of transverse myelitis, spinal infarction, acute disseminated encephalomyelitis, fever-induced refractory epileptic encephalopathy in school-aged children, small-vessel vasculitis, Griscelli syndrome type 2, cysticercosis, vitamin B12 deficiency, and chronic relapsing inflammatory optic neuropathy are presented.
Developmental Maxillofacial Anomalies Baxter, Daniel J.G., MD, CM, FRCPC; Shroff, Manohar M., MD, FRCPC
Seminars in ultrasound, CT, and MRI,
12/2011, Volume:
32, Issue:
6
Journal Article
Peer reviewed
There is a wide variety of developmental maxillofacial anomalies secondary to defective transformation of the first pair of pharyngeal arches into adult structures. Computed tomography and magnetic ...resonance imaging are essential to precisely define aberrant maxillofacial anatomy and guide appropriate management. This review article provides an overview of maxillofacial embryogenesis, clinical symptoms, and characteristic imaging features of several anomalies, including choanal atresia, congenital nasal piriform aperture stenosis, dacryocystoceles, nasolacrimal duct stenosis, cleft lip and palate, micrognathia, and midline nasal masses. Finally the major features of common first pharyngeal arch syndromes are discussed.
Congenital midface abnormalities Baxter, Daniel J G; Shroff, Manohar
Neuroimaging clinics of North America,
08/2011, Volume:
21, Issue:
3
Journal Article
Peer reviewed
There are a wide variety of congenital midface abnormalities that originate during transformation of the first pair of pharyngeal arches into adult structures. Computed tomography and magnetic ...resonance imaging are important components in the comprehensive evaluation of these lesions. A detailed understanding of midface embryogenesis and developmental anatomy is important in directing appropriate patient management.
