Joseph Maytal

In Whom Does Status Epilepticus Occur: Age-Related Differences in Children

: Purpose: Status epilepticus (SE) is an uncommon but potentially life‐threatening seizure. It is most common in children. Little is known about the differences within the pediatric age group in terms of the type of patient seen with SE.

The Role of Brain Computed Tomography in Evaluating Children with New Onset of Seizures in the Emergency Department

Summary: Background: The purpose of neuroimaging of a patient with new onset of seizures is to demonstrate cause and explore the prognosis. It was recently recommended that emergency brain computed tomography (CT) be performed only in adult seizure patients with an increased likelihood of life‐threatening lesions, i.e., those with new focal deficits, persistent altered mental status, fever, recent trauma, persistent headaches, history of cancer, history of anticoagulation, or suspicion of acquired immunodeficiency syndrome. The objective of this study was to determine the diagnostic utility of emergency brain CT in children who present to the emergency department with new onset of seizures.

Headaches in a pediatric emergency department : Etiology, imaging, and treatment

Objective.– To assess the spectrum of diagnoses, the use of CT scans of the brain, and pharmacological treatments in patients presenting to a pediatric emergency department with headaches as the chief complaint.

Short-Term Outcomes of Children with Febrile Status Epilepticus

Summary: Febrile status epilepticus (SE) represents the extreme end of the complex febrile seizure spectrum. If there are significant sequelae to febrile seizures, they should be more common in this group. We have prospectively identified 180 children aged 1 month to 10 years who presented with febrile SE over a 10‐year period in Bronx, New York, and Richmond, Virginia. They were compared with 244 children who presented with their first febrile seizure (not SE) in a prospective study done in the Bronx.

EEG and brain death determination in children

In a retrospective study involving several medical centers we identified 52 patients under age 5 years who met the adult clinical criteria for brain death and had at least one EEG with electrocerebral silence. Of the 52 patients, 31 died spontaneously and 21 were disconnected from the respirator. Repeat EEGs were obtained in 28 patients, and in all electrocerebral silence persisted. The study suggests that clinical criteria similar to those used for adults in the determination of brain death can also be applied to children above age 3 months and that a single EEG with electrocerebral silence is sufficient to confirm brain death in this age group.

Pseudotumor cerebri in Lyme disease : A case report and literature review

Pseudotumor cerebri is an unusual presentation of Lyme disease. The case of an 8-year-old girl with pseudotumor cerebri secondary to acute neuroborreliosis is reported. She presented with acute onset of headache, papilledema, sixth nerve palsy, increased intracranial pressure, and cerebrospinal fluid pleocytosis. Serum and cerebrospinal fluid Lyme antibodies were positive. Twelve reported cases that mostly presented with systemic findings and signs of Lyme disease before development of pseudotumor cerebri were reviewed. We conclude that acute neuroborreliosis can present with pseudotumor cerebri as an initial manifestation. It is important to include Lyme disease in the differential diagnosis of pseudotumor cerebri in an area endemic for Lyme disease.

The Value of Early Postictal EEG in Children with Complex Febrile Seizures

Summary: Purpose: To assess the usefulness of an early post‐ictal EEG in neurologically normal children with complex febrile seizures.

External hydrocephalus: a probable cause for subdural hematoma in infancy

Subdural hemorrhage is common in infancy, particularly in the first year of life. The most common cause is nonaccidental (child abuse), with accidental in second place. We present three healthy infants, ages 4, 5, and 7 months that, during an evaluation for macrocephaly, were found to have frontal subdural hematoma in association with prominent extracerebral cerebrospinal fluid spaces (external hydrocephalus). There was no history of trauma or risk factors for child abuse. Skull surveys and ophthalmologic examinations were normal. All infants were neurologically intact and achieved normal developmental milestones in one-year follow-up. We suggest that some infants with external hydrocephalus may be at risk for development of subdural hematoma with minimal or no trauma, most likely secondary to stretching of the bridging veins in the unusually widened subarachnoid spaces. Child abuse, although it should always be kept in mind and should be excluded, may not be the most common cause in this specific context.

Spontaneous spinal epidural hematoma: an uncommon presentation of a rare disease

Abstract.Introduction: Spontaneous spinal epidural hematoma is rare in children. The presenting symptoms are usually pain, either local or radicular, followed by progressive bilateral weakness, and sensory loss hours and even days later. In the absence of significant precipitating factors such as severe trauma or previously known coagulopathies the diagnosis is usually delayed, and it is not until the full picture of severe cord compression is developed, that MRI is done and the diagnosis is finally made. Case report: We describe a case of 10-year-old girl who presented with pain and pure brachial plexus radiculopathy as the only clinical manifestations of spinal epidural hematoma. Conclusion: A high index of suspicion can lead to the correct diagnosis even before the development of full cord compression and thus improve the overall prognosis.

Spontaneous spinal epidural hematoma in a 7-year-old girl: Diagnostic value of magnetic resonance imaging

The authors report a 7-year-old girl who developed neck pain and stiffness over a four-day period. There was no fever, trauma, systemic illness or headache. Physical examination demonstrated subtle neurologic deficits indicative of cervical cord compression. CAT scan and subsequent Magnetic Resonance Imaging (MRI) of the cervical spine demonstrated a spinal epidural hematoma, which was evacuated surgically. Post-operative angiography failed to demonstrate a vascular abnormality. The child recovered without neurologic deficit. MRI proved to be a sensitive tool in identifying the nature and extent of this lesion, and may be considered in lieu of myelography.