Ricardo Silva Pinho

Pediatric central nervous system tumors: a single-center experience from 1989 to 2009.

The objective of this study was to determine the epidemiology of primary tumors of the central nervous system (CNS) in pediatric patients from a Brazilian oncology institute. We retrospectively analyzed 741 charts (415 males and 326 females) of patients under 21 years of age who were diagnosed with a CNS tumor. The analysis included patients from 1989 to 2009 and was performed using the World Health Organization criteria. We evaluated the distribution of age, sex, topography, clinical symptoms, symptom intervals, and classification of the tumors. Patients with clinical/radiologic diagnoses were included. Seven hundred forty-one patients with tumors in the CNS were reviewed, and 83% of the patients presented a histologic diagnosis. Males (56%) were more prevalent than females. In children under the age of 1 year, the supratentorial compartment was the predominant region involved (62.0%). Astrocytoma was the most frequent tumor type (37.0%), followed by medulloblastoma (13.6%), craniopharyngioma (10.5%), and ependymoma (6.8%). Headaches were the most common symptom, and the symptom intervals varied from 1 to 5010 days. Approximately 4% of the patients had associated genetic syndromes. Although it was not a population study and selection bias may have occurred, this study supplies important epidemiologic data from an emerging country in which population studies are rare.

Sleep terrors antecedent is common in adolescents with migraine

UNLABELLED Migraines and sleep terrors (STs) are highly prevalent disorders with striking similarities. The aim of this study was to evaluate the effect of the antecedent of STs by comparing adolescents suffering from migraines with healthy controls in a large consecutive series. METHODS All patients were subjected to a detailed headache questionnaire and were instructed to keep a headache diary during a two-month period. The age range was 10 to 19 years. The diagnosis of STs was defined according to the International Classification of Sleep Disorders. RESULTS A total of 158 participants were evaluated. Of these participants, 50 suffered from episodic migraines (EMs), 57 had chronic migraines (CMs) and 51 were control subjects (CG). Participants who had a history of STs had significantly more migraines than participants who did not. CONCLUSIONS Migraine is strongly associated with a history of STs in the adolescent population independent of demographics and pain intensity.

Psychiatric symptoms may contribute to poor quality of life in adolescents with migraine

The impact of migraine on quality of life (QOL) can be aggravated by other comorbid factors. The aim of the present study was to assess the differences in the QOL of adolescents with chronic migraine, episodic migraine, and healthy adolescents, and whether the differences in QOL among the diagnostic groups were associated with the presence of self‐reported psychiatric symptoms, such as depression and anxiety.

Trigger factors mainly from the environmental type are reported by adolescents with migraine

UNLABELLED Migraine can be triggered by many factors such as stress, sleep, fasting and environmental causes. There are few studies that evaluated migraine trigger factors in the adolescent population. METHODS A total of 100 participants from 10 to 19 years were subjected to a detailed headache questionnaire, with demographic and clinical data, and a headache diary including trigger factors during a two-month period was asked. RESULTS Fifty of the participants exhibited chronic migraine and the other 50 participants demonstrated episodic migraine. The most common group of trigger factors reported was the environmental one, mainly sun/clarity, followed by hot weather and the smell of perfume. CONCLUSIONS Ninety-one percent of children and adolescents with migraine reported a trigger factor precipitating the migraine attack.

Migraine is frequent in children and adolescents with neurofibromatosis type 1.

Despite the high prevalence of headache in patients with neurofibromatosis type 1 (NF1), little data exist regarding the classification and characterization of headaches experienced by these patients. This paper describes a study of headache in patients with NF1 compared with healthy controls.

Hemifacial spasm as a manifestation of pilocytic astrocytoma in a pediatric patient

Hemifacial spasm is a disorder of the seventh cranial nerve, which is characterized by irregular, involuntary and recurrent tonic and clonic contractions of the ipsilateral facial expression muscles. This disorder affects mainly adults, and there are few cases reported in childhood. The main etiologies are vascular problems, although tumors are an important cause of hemifacial spasm via a direct or an indirect mass effect. We report a 6-year-old girl who presented with right hemifacial spasm. Magnetic resonance imaging showed a lesion in the cerebellopontine angle, extending from the midbrain to the pons with a slight mass effect on the fourth ventricle. The histological examination revealed a pilocytic astrocytoma.

An unusual cause of blindness: infarction in the bilateral lateral geniculate bodies.

A 10-year-old girl presented with acute blindness after a severe episode of febrile diarrhea. Magnetic resonance images were consistent with the diagnosis of infarction in the bilateral lateral geniculate bodies.

Fulminant idiopathic intracranial hypertension in a pediatric patient following a minor head trauma

Federal University of Sao Paulo Department of Neurology and Neurosurgery Division of Child Neurology

Detection of Cerebral Vasculopathy by Transcranial Doppler in Children With Neurofibromatosis Type 1

Neurofibromatosis type 1 is characterized by nerve sheath neurofibromas associated with a number of additional clinical features, including cerebrovascular disease. The aim of this study was to use transcranial Doppler as a screening method for identifying cerebral vasculopathy in children with neurofibromatosis type 1. Forty children with neurofibromatosis type 1, aged 5 to 18 years old, were examined by transcranial Doppler. Patients presenting with hemodynamic features of arterial stenosis/occlusion on transcranial Doppler underwent magnetic resonance angiography to confirm the findings. Magnetic resonance angiography was performed on 4 children who exhibited a transcranial Doppler hemodynamic pattern indicative of cerebral vasculopathy. Among these cases, 2 presented internal carotid artery stenosis/occlusion, 1 had bilateral middle cerebral artery stenosis, and 1 presented a normal magnetic resonance angiography result. Transcranial Doppler can be used routinely in the investigation of cerebrovascular disease in neurofibromatosis type 1 patients, where magnetic resonance angiography can be subsequently applied to confirm the diagnosis, further contributing to the prevention of cerebrovascular events.

Masruha et al. reply

SIR–We read with great interest and appreciation the comments made by Duman and Durmaz regarding our article. In their letter, they suggested that our patients’ symptoms may have been caused by a secondary effect of hypermelatoninemia, as they have previously described in a published case report. In their study, a female patient exhibited symptoms of spontaneous periodic hypothermia and hyperhidrosis. She displayed extremely high levels of melatonin in her serum and 6-hydroxymelatonin sulphate in urine samples obtained during her attacks. However, subsequent 24-hour urine studies revealed the presence of 5-hydroxyindoleacetic acid (5-HIAA) at 1.9 mg (normal), vanillylmandelic acid at 1.2 mg (normal), and homovanillic acid (HVA) at 2.2 mg (normal). These data are not in agreement with our findings, as both of our patient cases consistently demonstrated decreased levels of 5-HIAA and HVA in the cerebrospinal fluid. However, this inconsistency may be explained by a difference in the sensitivity of measurements obtained from urinary samples compared with measurements obtained from cerebrospinal fluid samples. We agree that increased levels of melatonin in blood and 6hydroxymelatonin sulphate in urine could be responsible for this disorder, and that hypermelatoninemia may explain our findings of low cerebrospinal fluid levels of 5-HIAA and HVA. We think that future studies examining melatonin levels as well as the determination of cerebrospinal fluid metabolites in the serum of patients who exhibit spontaneous hypothermia and hyperhidrosis will be very important, because only the reproduction of these findings will enable the determination of hypermelatoninemia as a cause of the disorder.