Arnold P. Gold

Primary Cerebral Arterial Occlusive Disease in Children

Of 87 children with acute acquired hemiplegia, 17 had primary arterial occlusions. These cases are analyzed in detail, and an angiographic classification presented. Each group showed a similarity between morphology and prognosis. Of interest are (1) correlation between the pattern of lenticulostriate artery occlusion and that of muscular weakness in basal occlusion without telangiectasia, (2) transcerebral anastomoses between lenticulostriate vessels and leptomeningeal branches of the middle cerebral artery in basal occlusion with telangiectasia, (3) angiographic findings of periarteritis nodosa. Angiography is particularly indicated if hemiplegia is associated with subarachnoid hemorrhage or with headache.

Screening for Autoantibodies in Children With Opsoclonus-Myoclonus-Ataxia

Various paraneoplastic autoantibodies have been linked to discrete neurologic syndromes and tumors in adults, but little is known about their incidence in children. We report a cross-sectional study of known paraneoplastic antibodies in 59 children with opsoclonus-myoclonus-ataxia, 86% of whom were moderately or severely symptomatic, and 68% of whom had relapsed at the time of testing. This total number of patients includes 18 children with low-stage neuroblastoma (tested after tumor resection), six of whom had never been treated with immunosuppressants. All were seronegative for anti-Hu, anti-Ri, and anti-Yo, the three paraneoplastic antibodies most associated with opsoclonus-myoclonus or ataxia in adults. These data contrast with reports of anti-Hu-positive sera in children with high-stage tumors and suggest that anti-Hu, anti-Ri, and anti-Yo do not explain relapses in pediatric opsoclonus-myoclonus-ataxia. They underscore the need to search for unique autoantibodies, as well as cellular mechanisms of pediatric paraneoplastic disease.

The impact of psychiatric intervention on patients with uncontrolled seizures

There is much evidence that emotional stress can trigger both neurogenic and hysterical seizures in susceptible patients. We reviewed our experience with 37 patients whose seizures appeared to be precipitated at times by emotional stress and had not been controlled by anticonvulsant medication alone. Approximately 70 per cent of patients demonstrated substantial improvement in seizure control after psychiatric treatment and maintained this improvement during follow-up. The findings of this study suggest that patient characteristics associated with better prognosis include normal intelligence, partial (as opposed to generalized) neurogenic seizures, a diagnosis of hysterical seizures, a less severely abnormal EEG, and being hypnotizable. After psychiatric treatment, 32 per cent of patients had their anticonvulsant medication reduced and another 16 per cent had it discontinued.

Acute Hemiplegia of Infancy and Childhood

In recent years, the hemiplegic child has not only benefited from improved diagnostic techniques, but has received a more rational therapeutic program based on sound developmental concepts. This article focuses on etiology and pathogenesis, clinical considerations, laboratory findings, computerized axial tomography, diagnosis, prognosis, and treatment.

Benign intracranial hypertension and Bell's palsy.

Benign intracranial hypertension is associated with a variety of underlying disorders, but the pathophysiology of the process is poorly understood. We have encountered three children with benign in...

Report of Joint Committee for Stroke Facilities-- IX. Strokes in Children (Part 1)

The study group assigned the task of reviewing what is known about strokes in children has performed an outstanding service in bringing to the attention of readers of Guidelines for Stroke Care an important but little-publicized subject. They have given an analysis in depth, covering epidemiology, neuropathology, diagnosis and medical treatment, neurosurgical management, neuroradiology, rehabilitation, and psychological and educational problems. Strokes occur in children much less frequently than in the adult population. Nevertheless their significance should not be underestimated or underemphasized, for they have unusual features because their impact affects the developing nervous system. The Strokes in Children section of the Report of the Joint Committee for Stroke Facilities is being published in two parts of which this is the first; the second part will appear in the November-December issue of this Journal.

IX. Strokes in Children (Part 2)

The Joint Committee for Stroke Facilities was created through a contract with Regional Medical Programs Service. The project upon which this publication is based was performed pursuant to Contract HSM-110-69-436 between the American Neurological Association and Health Services and Mental Health Administration, Department of Health, Education, and Welfare to help fulfill the requirements of Section 907 of Public Law 89-239, which established the Regional Medical Programs in 1965. The Committee hopes to review and update its guidelines periodically as new methods of diagnosis and treatment are developed. Comments, criticisms, and corrections are invited. They should be sent to:

CEREBRAL ARTERIOVENOUS MALFORMATIONS

with renal lesions*. One cannot help wondering if it is sometimes mistakenly diagnosed as pyelonephritis in children with myelomeningoceles and ventriculo-atrial shunts. Those caring for these children must remember that haematuria and albuminuria do not necessarily mean that the child has a urinary tract infection. The possibility of shunt nephritis and a low-grade septicaemia should be considered. The main features of such a septicaemia are anorexia, malaise, irritability, and an indolent fever which responds temporarily to antibiotic therapy and relapses when it is stopped. The children invariably have a severe anaemia, which is an important confirmatory sign2. Repeated blood cultures usually reveal Staphylococcus albus’, but sometimes blood culture is repeatedly sterile even though aspiration of fluid from the valve is positive or the bacteria are grown from the atrial end the catheters. Once the organism has been identified, antibiotics are given and the colonised shunt is removed as soon as possible. The nephritis should resolve within four months. Dept. of Paediatrics and Child Health, The University of Leeds, 27 Blundell St, Leeds LSl 3ET ROY MEADOW