Michael J. Bresnan

Radiation‐induced cerebrovascular disease in children

Radiation-induced internal carotid artery occlusion has not been well recognized previously as a cause of childhood cerebrovascular disease. A child who had received radiation as a neonate for a hemangioma involving the left orbit at the age of 6 years experienced a recurrent right-sided paresis, vascular headaches, and speech difficulties. Angiography showed a hypoplastic left carotid artery with occlusion of both the anterior and middle cerebral arteries. Collateral vessels bypassed the occluded-stenotic segments. Review of the literature showed two additional cases of large vessel occlusion in childhood associated with anastomatic telangiectatic vessel development following early radiation therapy of facial hemangioma.

Neonatal spinal cord transection secondary to intrauterine hyperextension of the neck in breech presentation

In the past three years we have dealt with children who suffered spinal cord transection during easy breech delivery. Each was discovered on prepartum roentgenogram to have been hyperextended in utero. Review of case reports of breech presentations in which there is persistent hyperextension indicates that transection of the cord does not occur if the infant is delivered by cesarean section; transection is estimated to occur in 25 per cent of those delivered vaginally. Pediatricians and pediatric neurologists should be aware of this unusual circumstance, especially when dealing with the neonate.

Neuropsychological impairment in duchenne muscular dystrophy

Fourteen younger (ages 6 to 10 years) and 11 older (ages 11 to 16 years) Duchenne Muscular Dystrophy (DMD) patients were tested with the WISC-R and neuropsychological language, visual-motor, and motor tasks. Older boys had an average IQ; younger boys were in the low average IQ range. Younger DMD boys were inferior to the older DMD group on tasks requiring some language and attentional-organizational skills, but not on visual-motor tasks. Older DMD boys were inferior on motor tasks. Results suggest that the reported low cognitive skills in DMD patients are not fixed or global, but reflect selective deficits in the younger boys. Possible bases for age differences in performance are discussed.

Lymphocyte capping in muscular dystrophy

We investigated lymphocyte capping in nine patients with muscular dystrophy (seven with Duchenne dystrophy and two with limb-girdle dystrophy), nine carriers, and five normal controls. No differences between the groups were observed. Thus, we have been unable to confirm a recent report that patients with muscular dystrophy, as well as carriers, have a defect in lymphocyte capping.

Cerebral embolism resulting from an intracardiac tumor in tuberous sclerosis

Tuberous sclerosis was diagnosed in an infant girl during the first 3 days of life on the basis of electrocardiographic and cranial computed tomographic abnormalities. At 19 months of age, neurologic deterioration occurred and repeat computed tomography documented several new cortical lesions while the subaortic mass was markedly reduced in size. The sequence of events suggested cerebral embolization by the cardiac tumor.

Neurologic Birth Injuries: Second of Two Parts

About three of every four spinal cord injuries in newborns are associated with breech deliveries. Peripheral nerve palsies outnumber the spinal injuries by almost 10 to 1. Occasionally, injuries occur within the uterus. Others are caused by incorrect placement of a gluteal injection or inadvertent injection of an analeptic or other agent into the umbilical artery.