Masaru Tatsuno

Epilepsy in Childhood Down Syndrome

This report concerns 844 children with Down syndrome under 15 years of age. Of the 844 cases with Down syndrome, 1.4% have epilepsy at the present time. The types of seizures are as follows; infantile spasms in 4 cases (30.8%), generalized tonic-clonic convulsions in 6 (46.1%), Lennox-Gastaut syndrome in 1 (7.7%) and psychomotor seizure in 2 (15.4%). The onset of seizure was high in the first two years (73.7%). The occurrence of epilepsy in Down syndrome in childhood did not differ from that in the general population, but infantile spasms were prevalent in Down syndrome.

Central nervous system disease in a child with primary Sjögren syndrome.

A 9-year-old girl had hemiparesis, and a diagnosis of primary Sjögren syndrome was made. The neurologic dysfunction was multifocal, involving both the brain and spinal cord, and was recurrent; the findings mimicked multiple sclerosis. Corticosteroid treatment during episodes of acute neurologic dysfunction appeared to be beneficial.

National survey of periventricular leukomalacia in Japan

Abstract Background: Clarification of the present status of periventricular leukomalacia (PVL) in Japan.

Intracranial vessels with color doppler echoencephalography in infants

A technique for imaging of the intracranial vessels in infants was described, which used high resolution, commercially available, color Doppler ultrasonography (real-time two-dimensional Doppler). On 12 normal infants, serial scans were obtained in sagittal, coronal, and axial plains. A large number of intracranial arteries and veins could be clearly demonstrated in real-time, including anterior cerebral artery, pericallosal artery, middle cerebral artery, posterior cerebral artery, basilar artery, communicating artery, internal cerebral vein, inferior and superior sagittal sinuses, great cerebral vein, straight sinus, occipital sinus and transverse sinus. In conclusion, color Doppler examination is useful in the detection of vessels in infants and in the measurement of intracranial blood flow velocity.

Characteristics of and weaning strategies in tube‐dependent children

Despite resolution of the symptoms of eating and/or swallowing disorders, prolonged tube feeding is maintained in some children. This study summarized the characteristics of children with tube dependence and investigated the causes of tube dependence.

Monitoring of immature rabbit brain during hypoxia with near-infrared spectroscopy

Continuous monitoring of the cerebral blood flow, oxyhemoglobin, deoxyhemoglobin, total hemoglobin, oxidized cytochrome a, a3, and tissue pH during prolonged CO2 or N2 loading in 2-week-old rabbits was performed by near-infrared spectroscopy, the thermocouple method, and a tissue pH meter. Near-infrared spectroscopy demonstrated decreases in oxyhemoglobin and oxidized cytochrome a, a3 and increases in deoxyhemoglobin and total hemoglobin in the early stage within 5 min, which gradually lessened with time on both 10% concentration of inspired O2 with CO2 and N2. CBF increased with venous retention in the early stage and then slowly decreased in parallel with blood pressure and oxidized cytochrome a, a3 on abolition of autoregulation. These changes were more remarkable during the 10% concentration of inspired O2 with CO2 than N2 which may be caused by marked acidosis and hypotension associated with hypercarbia. Oxidized cytochrome a, a3, however, demonstrated a gradual decrease in 10% concentration of inspired O2 with N2 rather than CO2; therefore, the continuous monitorings demonstrated hemodynamic and oxygenation changes despite the same extent of prolonged hypoxic loading. These changes in prolonged hypoxic conditions may occur in human intrapartum asphyxia which develops into postnatal hypoxic-ischemic encephalopathy.

Ventriculitis in infants: Diagnosis by color doppler flow imaging

A color Doppler flow imaging technique was used to study the dynamics of cerebrospinal fluid (CSF) in infants with meningitis. Eight infants with bacterial meningitis (6) or aseptic meningitis (2) were studied with color Doppler imaging of CSF flow for a total of 18 times. In 2 infants with bacterial meningitis, Doppler sonograms of CSF flow were obtained in the aqueduct during the acute stage. The CSF flow demonstrated a to-and-fro motion which was synchronized with cardiac pulsations and respiration. The detection of CSF flow on color Doppler flow imaging in the aqueduct may indicate the existence of ventriculitis. Color Doppler flow imaging is useful for the evaluation of CSF flow dynamics in infants.

Maturational change of KCl-induced Ca2+ increase in the rat brain synaptosomes.

To investigate maturational change in the susceptibility of voltage-dependent calcium (Ca2+) channels (VDCC) in the brain to excessive depolarization, which is likely to occur during hypoxia or ischemia, we studied depolarization-induced increases in Ca2+ concentration in cortical synaptosomes ([Ca2+]i) obtained from young (8, 15, 22, 36, and 43-day-old) and adult rats using fura 2-AM as a Ca2+ indicator. The effects of Ca2+ antagonists on the increase were also studied. The maximal increase in [Ca2+]i caused by 50 mM KCl-induced depolarization was significantly lower in 8-day-old rats (73.3 nM) compared with that in adult rats (133.6 nM). On the other hand, the time necessary for [Ca2+]i to decrease to 50% of its maximal level (tau) was significantly shorter in immature rats compared with that in adult rats and was particularly short in 8- and 15-day-old rats (0.28 and 0.40 min vs. 3.85 for adult rats). The maximal increase in [Ca2+]i in 22-day-old rats and tau in adult rats were markedly reduced by verapamil, omega-agatoxin IVA, and omega-conotoxin GVIA (antagonists of L-, P-, and N-type Ca2+ channels, respectively) to similar extents, while a mixture of the three antagonists markedly decreased both maximal increase and tau in 8- and 22-day-old and adult rats. These results indicate that depolarization-induced Ca2+ influx through VDCCs in immature rat brain is less pronounced than that in adult rats, and suggest that the susceptibility of all of L-, N-, and P-type Ca2+ channels is increased during maturation in the first few weeks after birth. This lower susceptibility to depolarization might be involved in the resistance to hypoxia in immature animals.

Continuous comparison of cerebral blood flow velocity and volume on hypoxia.

Cerebral blood flow velocity (CBFV) in the basilar artery, monitored by Doppler sonography, and cerebral blood flow (CBF) in the parietal cortex, monitored by Laser Doppler flowmetry, were continuously recorded and compared during and after hypoxic loading with nitrogen (N2) or carbon dioxide (CO2). On severe hypoxic loading (10% O2) of N2, CBFV and CBF increased with an increase in blood pressure (BP). On the other hand, with 18% and 15% O2 with CO2, CBFV and CBF increased with BP. However, there was a difference between CBF and CBFV in the recovery stage. CBF continued to be elevated for a long time, while CBFV rapidly normalized after loading. With 10% O2 with CO2, CBFV, CBF and BP decreased at first, and then increased during loading. Also, the difference between CBF and CBFV in the recovery stage being more definite. Thus, on continuous measurement, CBFV shows similar changes to CBF in response to hypoxia. However, CBFV shows different changes from CBF in association with dilatation or constriction of cerebral vessels. Resistance index (RI) shows different changes and have a different significance from CBF and CBFV.

Color doppler flow imaging of CSF flow in an infant with intraventricular hemorrhage

Evaluation of CSF flow was performed by means of the color Doppler flow imaging (CDFI) technique. The motion of CSF was examined in an infant with intraventricular hemorrhage (IVH). With the aid of CDFI, CSF flow in the aqueduct, 3rd ventricle and foramen of Monro could be demonstrated. CSF flow in both upward and downward directions was clearly visualized, primarily reflecting cardiac pulsation and respiration. When he was subjected with intermittent positive pressure ventilation, during inspiration there was upward flow in the aqueduct, while during expiration there was downward flow. Our experience indicates that CDFI is a useful technique for examining the CSF circulation in infants with IVH.