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Brain abscesses in infants and children
ABSTRACTS
401
presented were atypical in location and radiographic presentation. Randall HI. Powell
Surgical Relief of Progressive Upper Limb Paralysis in Arnold-Chiari M a l f o r m a t i o n . A. Gol and L. Hellbusch. J
Neurol Neurosurg Psychiatr 41:433-437, (May), 1978. NERVOUS SYSTEM Avoidance of Anencephalic and Spina Bifida Births by Maternal Serum-Alphafetoprotein Screening. M. A. Gerguson-Smith, H. A. Rawlinson, H. M. May, H. A. Tait, J. D. Vince, A. A. M. Gibson, H. P. Robinson, and J. G. Ratcliffe.
Lancet 1:1330 1332, (June), 1978. The authors report a pilot study to determine the benefits and disadvantages of a national screening program for neural tube defects. Pregnant women (11,585) were screened for raised serum alphafetoprotein between 16 and 20 wk of gestation. Of affected pregnancies 93%, (anencephaly 100%, open spina bifida 81.2%) were detected. Of false positives, 75.2% were excluded by a repeat serum sample or by ultrasonography. Of pregnancies, 0.063% proceeded to amniocentesis and of these, 46.6% showed raised amniotic alpha-fetoprotein levels due to fetal abnormality. Fetal loss following amniocentesis occurred in 0.034% of all those screened. The birth of 81.4% of babies with open neural tube defects (96.3% anencephalic, 56.2% open spina bifida) could be avoided reducing the incidence of all neural tube defects in the sample screen from 4.9/1000 to 1.5/ 1000. The authors stress that (1) screening must be voluntary; (2) a high standard of ultrasonography is essential; and (3) effective organisation is required for diagnostic tests and counseling. J. G. Harvey Growing Fractures of the Skull. D. Kingsley, K. Till, and R. Hoave. J Neurol Neurosurg Psychiatr 41:312 318, (April),
1978. The authors report on 10 cases collected over 10 yr. Six of the patients sustained the injury within 6 mo of life. The defects formed rapidly, several within 2-3 mo after injury. Most commonly, the parietal bone was involved. The edges of the defects were usually thickened. The ipsilateral ventricle was usually dilated and in a number was associated with a porencephalic cyst. In two, the latter connected with an extra-cranial fluid-filled cavity. The nature of the lesions is still not understood. The defects are almost unknown after the first few years of life. The single most important etiologic factor is a dural tear. Brain injury occurs beneath the fracture. At the edges of the defect, the brain and meninges are adherent. In this series, there was considerable damage to the underlying brain but none had neurologic symptoms.-R. J. Brereton Subdural Hematoma and the Malfunctioning Shunt. A. H. Moussa and S. K. Sharma. J Neurol Neurosurg Psychiatr
The authors review the subject and previous literature. They report 2 patients, 1, a girl of 13 yr, the other a man of 46, and describe relief of symptoms and signs by various operations upon the cervical spine. The girl had hydrocephalus but neither patient had spina bifida. The problem of hydromyelia of the cervical cord and upper limb weakness is not rare in older children with spina bifida, and it is likely that at least some of these teenagers would benefit from the procedures described by these authors in this preliminary report.--R. J. Brereton Brain Abscesses in Infants and Children. Z. H. ldriss, L. T. Gutman, and N. M. Kronfol. Clin Pediatr 17:738-746,
(October), 1978. Forty-two children presented with brain abscesses with two being found at post-mortem. Twenty-five patients were treated at the American University Medical Center (Beirut) and 17 at the Duke University Medical Center. Ages ranged from 1 mo to 18 yr with 9 patients being less than 1 yr of age. Most presented with fever, headache, and vomiting, and less commonly, with other neurologic signs. The complex of otitis-mastoiditis-sinusitis and congenital cyanotic heart disease were the most common underlying disease processes. Six of the 9 patients less than 1 yr had meningitis and 3 had cyanotic heart disease. Staph aureus and anaerobic or microaerophilic streptococci represented 18 of the 34 cases from which bacteria were isolated. Sixteen (38%) patients recovered completely and 12 (29%) were left with residual neurologic deficits. Fourteen (35%) patients died, I0 of these presenting with drowsiness or coma. Prompt recognition, now aided by CT scans, antibiotic treatment, and prompt surgical drainage should lower the high mortality and morbidity.--Randall HI. Powell Squamous Cell Carcinoma Arising in a Meningomyelocele. J. M. Saksun and B. K. Fisher. Can Med Assoc J 119:739741, (October), 1978.
Squamous cell carcinoma developed in an untreated meningomyelocele of a 25-yr-old man. The lesion was biopsled and then treated by radiation therapy. Eight weeks after completion of treatment, the patient died of meningitis despite antibiotic therapy. The authors stress the need for careful observation of patients with chronic scars, ulcers, and areas of inflammation, and recommend early biopsy to detect malignant change in any such lesion which undergoes a significant change in appearance.--Colin C. Ferguson
41:759 761, (August), 1978. NEOPLASMS Of 30 consecutive children with hydrocephalus treated by shunt implant, 6 developed subdural hematoma. Four presented with a malfunctioning shunt. The diagnosis in all six was made by a CAT scan. Five of the six had low pressure Pudenz ventriculo-atrial shunts. Of the 6, 3 had the hematomas evacuated through burr holes and 1 died. Of the remaining three, none required treatment. It is thought that the low pressure valve was an important etiologic factor.--R. J. Brereton
Testicular Histology After Combination Chemotherapy in Childhood for Acute Lymphoblastic Leukemia. M. Lendon, 1. M. Hann, M. K. Palmer, S. M. Shalet, and P. H. Morris Jones. Lancet 2:439-441, (August), 1978.
A study of testicular histology in 44 boys treated with combination chemotherapy for acute lymphoblastic leukemia. Twenty-one boys were still being treated with cytotoxic drugs; 23 had completed the course of treatment at times
401
presented were atypical in location and radiographic presentation. Randall HI. Powell
Surgical Relief of Progressive Upper Limb Paralysis in Arnold-Chiari M a l f o r m a t i o n . A. Gol and L. Hellbusch. J
Neurol Neurosurg Psychiatr 41:433-437, (May), 1978. NERVOUS SYSTEM Avoidance of Anencephalic and Spina Bifida Births by Maternal Serum-Alphafetoprotein Screening. M. A. Gerguson-Smith, H. A. Rawlinson, H. M. May, H. A. Tait, J. D. Vince, A. A. M. Gibson, H. P. Robinson, and J. G. Ratcliffe.
Lancet 1:1330 1332, (June), 1978. The authors report a pilot study to determine the benefits and disadvantages of a national screening program for neural tube defects. Pregnant women (11,585) were screened for raised serum alphafetoprotein between 16 and 20 wk of gestation. Of affected pregnancies 93%, (anencephaly 100%, open spina bifida 81.2%) were detected. Of false positives, 75.2% were excluded by a repeat serum sample or by ultrasonography. Of pregnancies, 0.063% proceeded to amniocentesis and of these, 46.6% showed raised amniotic alpha-fetoprotein levels due to fetal abnormality. Fetal loss following amniocentesis occurred in 0.034% of all those screened. The birth of 81.4% of babies with open neural tube defects (96.3% anencephalic, 56.2% open spina bifida) could be avoided reducing the incidence of all neural tube defects in the sample screen from 4.9/1000 to 1.5/ 1000. The authors stress that (1) screening must be voluntary; (2) a high standard of ultrasonography is essential; and (3) effective organisation is required for diagnostic tests and counseling. J. G. Harvey Growing Fractures of the Skull. D. Kingsley, K. Till, and R. Hoave. J Neurol Neurosurg Psychiatr 41:312 318, (April),
1978. The authors report on 10 cases collected over 10 yr. Six of the patients sustained the injury within 6 mo of life. The defects formed rapidly, several within 2-3 mo after injury. Most commonly, the parietal bone was involved. The edges of the defects were usually thickened. The ipsilateral ventricle was usually dilated and in a number was associated with a porencephalic cyst. In two, the latter connected with an extra-cranial fluid-filled cavity. The nature of the lesions is still not understood. The defects are almost unknown after the first few years of life. The single most important etiologic factor is a dural tear. Brain injury occurs beneath the fracture. At the edges of the defect, the brain and meninges are adherent. In this series, there was considerable damage to the underlying brain but none had neurologic symptoms.-R. J. Brereton Subdural Hematoma and the Malfunctioning Shunt. A. H. Moussa and S. K. Sharma. J Neurol Neurosurg Psychiatr
The authors review the subject and previous literature. They report 2 patients, 1, a girl of 13 yr, the other a man of 46, and describe relief of symptoms and signs by various operations upon the cervical spine. The girl had hydrocephalus but neither patient had spina bifida. The problem of hydromyelia of the cervical cord and upper limb weakness is not rare in older children with spina bifida, and it is likely that at least some of these teenagers would benefit from the procedures described by these authors in this preliminary report.--R. J. Brereton Brain Abscesses in Infants and Children. Z. H. ldriss, L. T. Gutman, and N. M. Kronfol. Clin Pediatr 17:738-746,
(October), 1978. Forty-two children presented with brain abscesses with two being found at post-mortem. Twenty-five patients were treated at the American University Medical Center (Beirut) and 17 at the Duke University Medical Center. Ages ranged from 1 mo to 18 yr with 9 patients being less than 1 yr of age. Most presented with fever, headache, and vomiting, and less commonly, with other neurologic signs. The complex of otitis-mastoiditis-sinusitis and congenital cyanotic heart disease were the most common underlying disease processes. Six of the 9 patients less than 1 yr had meningitis and 3 had cyanotic heart disease. Staph aureus and anaerobic or microaerophilic streptococci represented 18 of the 34 cases from which bacteria were isolated. Sixteen (38%) patients recovered completely and 12 (29%) were left with residual neurologic deficits. Fourteen (35%) patients died, I0 of these presenting with drowsiness or coma. Prompt recognition, now aided by CT scans, antibiotic treatment, and prompt surgical drainage should lower the high mortality and morbidity.--Randall HI. Powell Squamous Cell Carcinoma Arising in a Meningomyelocele. J. M. Saksun and B. K. Fisher. Can Med Assoc J 119:739741, (October), 1978.
Squamous cell carcinoma developed in an untreated meningomyelocele of a 25-yr-old man. The lesion was biopsled and then treated by radiation therapy. Eight weeks after completion of treatment, the patient died of meningitis despite antibiotic therapy. The authors stress the need for careful observation of patients with chronic scars, ulcers, and areas of inflammation, and recommend early biopsy to detect malignant change in any such lesion which undergoes a significant change in appearance.--Colin C. Ferguson
41:759 761, (August), 1978. NEOPLASMS Of 30 consecutive children with hydrocephalus treated by shunt implant, 6 developed subdural hematoma. Four presented with a malfunctioning shunt. The diagnosis in all six was made by a CAT scan. Five of the six had low pressure Pudenz ventriculo-atrial shunts. Of the 6, 3 had the hematomas evacuated through burr holes and 1 died. Of the remaining three, none required treatment. It is thought that the low pressure valve was an important etiologic factor.--R. J. Brereton
Testicular Histology After Combination Chemotherapy in Childhood for Acute Lymphoblastic Leukemia. M. Lendon, 1. M. Hann, M. K. Palmer, S. M. Shalet, and P. H. Morris Jones. Lancet 2:439-441, (August), 1978.
A study of testicular histology in 44 boys treated with combination chemotherapy for acute lymphoblastic leukemia. Twenty-one boys were still being treated with cytotoxic drugs; 23 had completed the course of treatment at times