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Orr SL. Headache in Children and Adolescents. Continuum (Minneap Minn) 2024; 30:438-472. [PMID: 38568493 DOI: 10.1212/con.0000000000001414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
OBJECTIVE This article reviews the assessment of children and adolescents presenting with headache, provides an overview of primary headache disorders, and reviews evidence-based management of headache in this age group. LATEST DEVELOPMENTS In the last few years, new epidemiological data have shed light on less common pediatric headache disorders (eg, pediatric trigeminal autonomic cephalalgias) and psychosocial risk factors associated with primary headache disorders in children and adolescents. There has also recently been a substantial increase in interventions that target the calcitonin gene-related peptide pathway and that treat primary headache disorders using noninvasive neuromodulation. Although these interventions have primarily been studied in adults, there is emerging evidence of their use in the pediatric population. ESSENTIAL POINTS Primary headache disorders are very common in youth, and the most commonly encountered headache diagnosis in neurology practice is migraine, which affects approximately 10% of children and adolescents. Diagnosing and effectively treating primary headache disorders before adulthood may have a sustained impact on the patient by improving long-term headache and mental health outcomes, thereby significantly reducing the burden of disability over time. There are several available and emerging acute and preventive interventions for youth with primary headache disorders, and treatment decisions should be made in the context of available evidence using a shared decision-making approach.
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van Genderen JG, Chia C, Van den Hof M, Mutsaerts HJMM, Reneman L, Pajkrt D, Schrantee A. Brain Differences in Adolescents Living With Perinatally Acquired HIV Compared With Adoption Status Matched Controls: A Cross-sectional Study. Neurology 2022; 99:e1676-e1684. [PMID: 35940898 PMCID: PMC9559945 DOI: 10.1212/wnl.0000000000200946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/20/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite effective combination antiretroviral therapy (cART), adolescents with perinatally acquired HIV (PHIV) exhibit cognitive impairment, of which structural changes could be the underlying pathophysiologic mechanism. Prior MRI studies found lower brain volumes, higher white matter (WM) hyperintensity (WMH) volume, lower WM integrity, and differences in cerebral blood flow (CBF). However, these findings may be confounded by adoption status, as a large portion of adolescents with PHIV have been adopted. Adoption has been associated with malnutrition and neglect, which, in turn, may have affected brain development. We investigated the long-term effects of PHIV on the brain, while minimizing the confounding effect of adoption status. METHODS We determined whole-brain gray matter (GM) and WM volume with 3D T1-weighted scans; total WMH volume with fluid-attenuated inversion recovery; CBF in the following regions of interest (ROIs): WM, GM, and subcortical GM with arterial spin labeling; and whole-brain WM microstructural markers: fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) with diffusion tensor imaging in cART-treated adolescents with PHIV visiting our outpatient clinic in Amsterdam and controls matched for age, sex, ethnic origin, socioeconomic status, and adoption status. We assessed differences in neuroimaging parameters between adolescents with PHIV and controls using linear regression models adjusted for age and sex and applied multiple comparison correction. RESULTS Thirty-five adolescents with PHIV and 38 controls were included with a median age of 14.9 (interquartile range [IQR]: 10.7-18.5) and 15.6 (IQR: 11.1-17.6) years, respectively, with a similar rate of adoption. We found a lower overall FA (beta = -0.012; p < 0.014, -2.4%), a higher MD (beta = 0.014, p = 0.014, 1.3%), and a higher RD (beta = 0.02, p = 0.014, 3.3%) in adolescents with PHIV vs adoption-matched controls, but no differences in AD. We found comparable GM, WM, and WMH volume and CBF in ROIs between adolescents with PHIV and controls. We did not find an association between cognitive profiles and WM microstructural markers in adolescents with PHIV. DISCUSSION Irrespective of adoption status, adolescents with PHIV exhibited subtle lower WM integrity. Our findings may point toward early-acquired WM microstructural alterations associated with HIV.
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Affiliation(s)
- Jason G van Genderen
- From the Department of Pediatric Infectious Diseases (J.G.G., C.C., M.V.H., D.P.), Emma Children's Hospital, Amsterdam UMC, Location Academic Medical Center, the Netherlands; Department of Radiology and Nuclear Medicine (H.J.M.M.M.), Amsterdam University Medical Centers, Location VU Medical Center, University of Amsterdam, the Netherlands; and Department of Radiology and Nuclear Medicine (L.R., A.S.), Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, the Netherlands.
| | - Cecilia Chia
- From the Department of Pediatric Infectious Diseases (J.G.G., C.C., M.V.H., D.P.), Emma Children's Hospital, Amsterdam UMC, Location Academic Medical Center, the Netherlands; Department of Radiology and Nuclear Medicine (H.J.M.M.M.), Amsterdam University Medical Centers, Location VU Medical Center, University of Amsterdam, the Netherlands; and Department of Radiology and Nuclear Medicine (L.R., A.S.), Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, the Netherlands
| | - Malon Van den Hof
- From the Department of Pediatric Infectious Diseases (J.G.G., C.C., M.V.H., D.P.), Emma Children's Hospital, Amsterdam UMC, Location Academic Medical Center, the Netherlands; Department of Radiology and Nuclear Medicine (H.J.M.M.M.), Amsterdam University Medical Centers, Location VU Medical Center, University of Amsterdam, the Netherlands; and Department of Radiology and Nuclear Medicine (L.R., A.S.), Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, the Netherlands
| | - Henk J M M Mutsaerts
- From the Department of Pediatric Infectious Diseases (J.G.G., C.C., M.V.H., D.P.), Emma Children's Hospital, Amsterdam UMC, Location Academic Medical Center, the Netherlands; Department of Radiology and Nuclear Medicine (H.J.M.M.M.), Amsterdam University Medical Centers, Location VU Medical Center, University of Amsterdam, the Netherlands; and Department of Radiology and Nuclear Medicine (L.R., A.S.), Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, the Netherlands
| | - Liesbeth Reneman
- From the Department of Pediatric Infectious Diseases (J.G.G., C.C., M.V.H., D.P.), Emma Children's Hospital, Amsterdam UMC, Location Academic Medical Center, the Netherlands; Department of Radiology and Nuclear Medicine (H.J.M.M.M.), Amsterdam University Medical Centers, Location VU Medical Center, University of Amsterdam, the Netherlands; and Department of Radiology and Nuclear Medicine (L.R., A.S.), Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, the Netherlands
| | - Dasja Pajkrt
- From the Department of Pediatric Infectious Diseases (J.G.G., C.C., M.V.H., D.P.), Emma Children's Hospital, Amsterdam UMC, Location Academic Medical Center, the Netherlands; Department of Radiology and Nuclear Medicine (H.J.M.M.M.), Amsterdam University Medical Centers, Location VU Medical Center, University of Amsterdam, the Netherlands; and Department of Radiology and Nuclear Medicine (L.R., A.S.), Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, the Netherlands
| | - Anouk Schrantee
- From the Department of Pediatric Infectious Diseases (J.G.G., C.C., M.V.H., D.P.), Emma Children's Hospital, Amsterdam UMC, Location Academic Medical Center, the Netherlands; Department of Radiology and Nuclear Medicine (H.J.M.M.M.), Amsterdam University Medical Centers, Location VU Medical Center, University of Amsterdam, the Netherlands; and Department of Radiology and Nuclear Medicine (L.R., A.S.), Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, the Netherlands
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AYDIN H, YAZICI S, ÖZDEN E, DEMİRPOLAT G. Retrospective features of cases with cranial magnetic resonance imaging. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1126762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: In this study, we aimed to reveal the diagnostic profiles of 0-18 years aged patients, for whom cranial magnetic resonance imaging is requested in outpatient settings, and to evaluate the cranial imaging results according to gender and age groups.
Materials and Methods: The files of patients aged 0-18 years who were requested cranial magnetic resonance imaging for various indications, between August 2019 and March 2021, in Balikesir University, Faculty of Medicine pediatric neurology and pediatric health and diseases outpatient clinics were reviewed retrospectively.
Age, gender, main complaint and neuroradiological imaging results were obtained from hospital records. Data were divided for three different age groups (0-6, 7-12, 13-18).
Results: Cranial magnetic resonance imaging of 313 cases were analyzed. The mean age of the patients was 9.35±4.89 (4 months-17 years) years. There were 164 (52.4%) boys and 149 (47.6%) girls. There were 82 (26.2%) cases in the 0-6 years age group, 104 (33.2%) in the 7-12 years age group and 127 (40.6%) in the 13-18 years age group. The most common reasons for requesting cranial magnetic resonance imaging were as; seizure/epilepsy in 106 (33.9%) cases, headache in 65 (20.8%) cases, and neuromotor retardation in 28 (8.9%) cases. While the cranial imaging of 200 (63.9%) cases was normal, the results of 113 (36.1%) cases were evaluated as abnormal. The most common abnormal findings were intracranial mass (2.5%), nonspecific white matter lesion (5.1%), intracranial cyst (5.7%), sinusitis (9.2%) and hydrocephalus/hydrancephaly (2.6%). When age groups were compared in terms of showing normal or abnormal cranial imaging findings, no statistically significant difference was found (p=0.73), but a statistically significant difference was found between the genders in the same respect (p=0.007).
Conclusion: Our study is important for including cranial MRI request indications and results in pediatric practice and it creating a diagnostic profile in these patients.
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Affiliation(s)
- Hilal AYDIN
- Balıkesir Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Çocuk Nöroloji Bölümü, Balıkesir, Türkiye
| | - Selçuk YAZICI
- Balıkesir Ün vers tes Tıp Fakültes Çocuk Sağlığı ve Hastalıkları Ana l m Dalı, Çocuk Hastalıkları Bölümü, Balıkesir, Türkiye
| | - Ezgi ÖZDEN
- Balıkesir Ün vers tes Tıp Fakültes Çocuk Sağlığı ve Hastalıkları Ana l m Dalı, Çocuk Hastalıkları Bölümü, Balıkesir, Türkiye
| | - Gülen DEMİRPOLAT
- Balıkesir Üniversitesi Tıp Fakültesi Radyoloji Ana ilim Dalı, Balıkesir, Türkiye
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Prevalence of incidental intracranial findings on magnetic resonance imaging: a systematic review and meta-analysis. Acta Neurochir (Wien) 2022; 164:2751-2765. [PMID: 35525892 PMCID: PMC9519720 DOI: 10.1007/s00701-022-05225-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/22/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND As the volume and fidelity of magnetic resonance imaging (MRI) of the brain increase, observation of incidental findings may also increase. We performed a systematic review and meta-analysis to determine the prevalence of various incidental findings. METHODS PubMed/MEDLINE, EMBASE and SCOPUS were searched from inception to May 24, 2021. We identified 6536 citations and included 35 reports of 34 studies, comprising 40,777 participants. A meta-analysis of proportions was performed, and age-stratified estimates for each finding were derived from age-adjusted non-linear models. RESULTS Vascular abnormalities were observed in 423/35,706 participants (9.1/1000 scans, 95%CI 5.2-14.2), ranging from 2/1000 scans (95%CI 0-7) in 1-year-olds to 16/1000 scans (95%CI 1-43) in 80-year-olds. Of these, 204/34,306 were aneurysms (3.1/1000 scans, 95%CI 1-6.3), which ranged from 0/1000 scans (95%CI 0-5) at 1 year of age to 6/1000 scans (95%CI 3-9) at 60 years. Neoplastic abnormalities were observed in 456/39,040 participants (11.9/1000 scans, 95%CI 7.5-17.2), ranging from 0.2/1000 scans (95%CI 0-10) in 1-year-olds to 34/1000 scans (95%CI 12-66) in 80-year-olds. Meningiomas were the most common, in 246/38,076 participants (5.3/1000 scans, 95%CI 2.3-9.5), ranging from 0/1000 scans (95%CI 0-2) in 1-year-olds to 17/1000 scans (95%CI 4-37) in 80-year-olds. Chiari malformations were observed in 109/27,408 participants (3.7/1000 scans, 95%CI 1.8-6.3), pineal cysts in 1176/32,170 (9/1000 scans, 95%CI 1.8-21.4) and arachnoid cysts in 414/36,367 (8.5/1000 scans, 95%CI 5.8-11.8). CONCLUSION Incidental findings are common on brain MRI and may result in substantial resource expenditure and patient anxiety but are often of little clinical significance.
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Merison K, Victorio MCC. Approach to the Diagnosis of Pediatric Headache. Semin Pediatr Neurol 2021; 40:100920. [PMID: 34749917 DOI: 10.1016/j.spen.2021.100920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/09/2021] [Accepted: 08/15/2021] [Indexed: 10/20/2022]
Abstract
Headache in children and adolescents is a common symptom that can be worrisome to patients, their parents and clinicians due to the myriad of underlying etiologies, both benign and life-threatening. The evaluation of headache must be directed primarily to exclude secondary causes. A detailed headache history, recognition of headache patterns and red flags and thorough physical and neurological examinations are essential in the diagnosis; and identifies patients requiring further workup. Considerations for neuroimaging and ancillary testing are also discussed.
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Affiliation(s)
- Kelsey Merison
- NeuroDevelopmental Science Center Akron Children's Hospital, Akron, OH.
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Li Y, Thompson WK, Reuter C, Nillo R, Jernigan T, Dale A, Sugrue LP, Brown J, Dougherty RF, Rauschecker A, Rudie J, Barch DM, Calhoun V, Hagler D, Hatton S, Tanabe J, Marshall A, Sher KJ, Heeringa S, Hermosillo R, Banich MT, Squeglia L, Bjork J, Zucker R, Neale M, Herting M, Sheth C, Huber R, Reeves G, Hettema JM, Howlett KD, Cloak C, Baskin-Sommers A, Rapuano K, Gonzalez R, Karcher N, Laird A, Baker F, James R, Sowell E, Dick A, Hawes S, Sutherland M, Bagot K, Bodurka J, Breslin F, Morris A, Paulus M, Gray K, Hoffman E, Weiss S, Rajapakse N, Glantz M, Nagel B, Ewing SF, Goldstone A, Pfefferbaum A, Prouty D, Rosenberg M, Bookheimer S, Tapert S, Infante M, Jacobus J, Giedd J, Shilling P, Wade N, Uban K, Haist F, Heyser C, Palmer C, Kuperman J, Hewitt J, Cottler L, Isaiah A, Chang L, Edwards S, Ernst T, Heitzeg M, Puttler L, Sripada C, Iacono W, Luciana M, Clark D, Luna B, Schirda C, Foxe J, Freedman E, Mason M, McGlade E, Renshaw P, Yurgelun-Todd D, Albaugh M, Allgaier N, Chaarani B, Potter A, Ivanova M, Lisdahl K, Do E, Maes H, Bogdan R, Anokhin A, Dosenbach N, Glaser P, Heath A, Casey BJ, Gee D, Garavan HP, Dowling G, Brown S. Rates of Incidental Findings in Brain Magnetic Resonance Imaging in Children. JAMA Neurol 2021; 78:578-587. [PMID: 33749724 PMCID: PMC7985817 DOI: 10.1001/jamaneurol.2021.0306] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Importance Incidental findings (IFs) are unexpected abnormalities discovered during imaging and can range from normal anatomic variants to findings requiring urgent medical intervention. In the case of brain magnetic resonance imaging (MRI), reliable data about the prevalence and significance of IFs in the general population are limited, making it difficult to anticipate, communicate, and manage these findings. Objectives To determine the overall prevalence of IFs in brain MRI in the nonclinical pediatric population as well as the rates of specific findings and findings for which clinical referral is recommended. Design, Setting, and Participants This cohort study was based on the April 2019 release of baseline data from 11 810 children aged 9 to 10 years who were enrolled and completed baseline neuroimaging in the Adolescent Brain Cognitive Development (ABCD) study, the largest US population-based longitudinal observational study of brain development and child health, between September 1, 2016, and November 15, 2018. Participants were enrolled at 21 sites across the US designed to mirror the demographic characteristics of the US population. Baseline structural MRIs were centrally reviewed for IFs by board-certified neuroradiologists and findings were described and categorized (category 1, no abnormal findings; 2, no referral recommended; 3; consider referral; and 4, consider immediate referral). Children were enrolled through a broad school-based recruitment process in which all children of eligible age at selected schools were invited to participate. Exclusion criteria were severe sensory, intellectual, medical, or neurologic disorders that would preclude or interfere with study participation. During the enrollment process, demographic data were monitored to ensure that the study met targets for sex, socioeconomic, ethnic, and racial diversity. Data were analyzed from March 15, 2018, to November 20, 2020. Main Outcomes and Measures Percentage of children with IFs in each category and prevalence of specific IFs. Results A total of 11 679 children (52.1% boys, mean [SD] age, 9.9 [0.62] years) had interpretable baseline structural MRI results. Of these, 2464 participants (21.1%) had IFs, including 2013 children (17.2%) assigned to category 2, 431 (3.7%) assigned to category 3, and 20 (0.2%) assigned to category 4. Overall rates of IFs did not differ significantly between singleton and twin gestations or between monozygotic and dizygotic twins, but heritability analysis showed heritability for the presence or absence of IFs (h2 = 0.260; 95% CI, 0.135-0.387). Conclusions and Relevance Incidental findings in brain MRI and findings with potential clinical significance are both common in the general pediatric population. By assessing IFs and concurrent developmental and health measures and following these findings over the longitudinal study course, the ABCD study has the potential to determine the significance of many common IFs.
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Affiliation(s)
- Yi Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Wesley K. Thompson
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Chase Reuter
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Ryan Nillo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Terry Jernigan
- Center for Human Development, University of California, San Diego, La Jolla
| | - Anders Dale
- Center for Human Development, University of California, San Diego, La Jolla
| | - Leo P. Sugrue
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | | | - Julian Brown
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Robert F Dougherty
- Center for Cognitive and Neurobiological Imaging, Stanford University, Stanford, California
| | - Andreas Rauschecker
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Jeffrey Rudie
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Psychiatry, Radiology, Washington University in St Louis, St Louis, Missouri
| | - Vince Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science, Georgia State University, Georgia Tech, Emory University, Atlanta
| | - Donald Hagler
- Department of Radiology, University of California, San Diego, La Jolla
| | - Sean Hatton
- Department of Neurosciences, University of California, San Diego, La Jolla
| | - Jody Tanabe
- Department of Radiology, University of Colorado Anschutz Medical Center, Aurora
| | - Andrew Marshall
- Department of Pediatrics, Children's Hospital Los Angeles/University of Southern California, Los Angeles
| | - Kenneth J Sher
- Department of Psychological Sciences, University of Missouri, Columbia
| | - Steven Heeringa
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Robert Hermosillo
- Department of Behavioral Neuroscience, Oregon Health Sciences University, Portland
| | - Marie T Banich
- Institute of Cognitive Science, Department of Psychology and Neuroscience, University of Colorado, Boulder
| | - Lindsay Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - James Bjork
- Department of Psychiatry, Virginia Commonwealth University, Richmond
| | - Robert Zucker
- Department of Psychiatry and Psychology, University of Michigan, Ann Arbor
| | - Michael Neale
- Department of Psychiatry, Virginia Commonwealth University, Richmond
| | - Megan Herting
- Department of Preventive Medicine, University of Southern California, Los Angeles
| | - Chandni Sheth
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City
| | - Rebeka Huber
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City
| | - Gloria Reeves
- Department of Psychiatry, University of Maryland, Baltimore
| | - John M Hettema
- Department of Psychiatry, Texas A&M Health Science Center, Bryan
| | - Katia Delrahim Howlett
- Division of Extramural Research, National Institute on Drug Abuse/National Institutes of Health, Bethesda, Maryland
| | - Christine Cloak
- Department of Radiology and Nuclear Medicine, University of Maryland, Baltimore
| | | | - Kristina Rapuano
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Raul Gonzalez
- Department of Psychology, Florida International University, Miami
| | - Nicole Karcher
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Angela Laird
- Department of Physics, Florida International University, Miami
| | | | - Regina James
- Department of Clinical Research, 2M Research Services, Arlington, Virginia
| | - Elizabeth Sowell
- Department of Pediatrics, Children's Hospital Los Angeles/University of Southern California, Los Angeles
| | - Anthony Dick
- Department of Psychology, Florida International University, Miami
| | - Samuel Hawes
- Department of Psychology, Florida International University, Miami
| | | | - Kara Bagot
- Department of Psychiatry, Icahn School of Medicine at Mt Sinai, New York, New York
| | - Jerzy Bodurka
- Laureate Institute for Brain Research, Tulsa, Oklahoma
| | | | - Amanda Morris
- Laureate Institute for Brain Research, Tulsa, Oklahoma
| | - Martin Paulus
- Laureate Institute for Brain Research, Tulsa, Oklahoma
| | - Kevin Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Elizabeth Hoffman
- Division of Extramural Research, National Institute on Drug Abuse/National Institutes of Health, Bethesda, Maryland
| | - Susan Weiss
- Division of Extramural Research, National Institute on Drug Abuse/National Institutes of Health, Bethesda, Maryland
| | - Nishadi Rajapakse
- Department of Scientific Programs, National Institute on Minority Health and Health Disparities, Bethesda, Maryland
| | - Meyer Glantz
- Department of Psychology, National Institute on Drug Abuse/National Institutes of Health, Bethesda, Maryland
| | - Bonnie Nagel
- Department of Psychiatry, Oregon Health and Science University, Portland
| | | | | | | | | | - Monica Rosenberg
- Department of Psychology, University of Chicago, Chicago, Illinois
| | - Susan Bookheimer
- Department of Psychiatry and Biobehavioral Sciences, School of Medicine, University of California, Los Angeles
| | - Susan Tapert
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Maria Infante
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Joanna Jacobus
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Jay Giedd
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Paul Shilling
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Natasha Wade
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Kristina Uban
- Department of Public Health, University of California, Irvine
| | - Frank Haist
- Department of Psychiatry and Center for Human Development, University of California, San Diego, La Jolla
| | - Charles Heyser
- Center for Human Development, University of California, San Diego, La Jolla
| | - Clare Palmer
- Center for Human Development, University of California, San Diego, La Jolla
| | - Joshua Kuperman
- Department of Radiology, University of California, San Diego, La Jolla
| | - John Hewitt
- Institute for Behavioral Genetics, University of Colorado, Boulder
| | - Linda Cottler
- Department of Epidemiology, University of Florida, Gainesville
| | - Amal Isaiah
- Department of Otorhinolaryngology/Head and Neck Surgery and Pediatrics, University of Maryland School of Medicine, Baltimore
| | - Linda Chang
- Departments of Radiology and Neurology, University of Maryland, Baltimore
| | - Sarah Edwards
- Department of Psychiatry, University of Maryland, Baltimore
| | - Thomas Ernst
- Department of Radiology, University of Maryland, Baltimore
| | - Mary Heitzeg
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - Leon Puttler
- Department of Psychiatry, University of Michigan, Ann Arbor
| | | | - William Iacono
- Department of Psychology, University of Minnesota, Minneapolis
| | - Monica Luciana
- Department of Psychology, University of Minnesota, Minneapolis
| | - Duncan Clark
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Claudiu Schirda
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John Foxe
- Department of Neuroscience, University of Rochester Medical Center, Rochester, New York
| | - Edward Freedman
- Department of Neuroscience, University of Rochester Medical Center, Rochester, New York
| | - Michael Mason
- Center for Behavioral Health Research, University of Tennessee, Knoxville
| | - Erin McGlade
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City
| | - Perry Renshaw
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City
| | | | | | | | - Bader Chaarani
- Department of Psychiatry, University of Vermont, Burlington
| | | | - Masha Ivanova
- Department of Psychiatry, University of Vermont, Burlington
| | - Krista Lisdahl
- Department of Psychiatry, University of Vermont, Burlington
| | - Elizabeth Do
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond
| | - Hermine Maes
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond
| | - Ryan Bogdan
- Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, Missouri
| | - Andrey Anokhin
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Nico Dosenbach
- Department of Neurology, Washington University in St Louis, St Louis, Missouri
| | - Paul Glaser
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Andrew Heath
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Betty J Casey
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Dylan Gee
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Hugh P Garavan
- Department of Psychiatry, University of Vermont, Burlington
| | - Gaya Dowling
- Division of Extramural Research, National Institute on Drug Abuse/National Institutes of Health, Bethesda, Maryland
| | - Sandra Brown
- Department of Psychiatry and Psychology, University of California, San Diego, La Jolla
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Evaluation of the Etiology, Clinical Presentation, Findings and Prophylaxis of Children with Headache. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2021; 55:128-133. [PMID: 33935547 PMCID: PMC8085460 DOI: 10.14744/semb.2019.36604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 04/15/2019] [Indexed: 11/20/2022]
Abstract
Objectives: A headache is prevalent in childhood and constitutes a significant part of outpatient applications. This study aimed to evaluate the results of etiology, clinical features, examination results, prophylactic treatment and follow-up in patients with a headache. Methods: Between January 2017 and December 2018, the files of the patients with the complaint of headache were reviewed retrospectively in this study. A headache was classified according to the International Headache Society (IHS) criteria. Results: In this study, 350 patients aged between 3-17 years old and the mean age of 11.2±2.7 with a headache were included; 212 (60.6%) of them was female and 138 (39.4%) of them was male. The rate of a primary headache was higher in females than in males (p=0.004). The headache causes were a migraine in 51.1%, tension-type headache in 32.3%, secondary in 13.4%, and not classified in 3.1%. The mean age of the patients with a primary headache was significantly higher than patients with a secondary headache (p<0.001). The most common trigger factor was insomnia (52.7%). Abnormal physical/neurological signs and symptoms were detected in 17 (9.49%) patients. Cranial magnetic resonance imaging (MRI) examination was performed in 121 (34.5%) patients. Abnormal findings were found in 35 (28.9%) of these. In this study, 33 patients underwent electroencephalography (EEG); none of the had an epileptiform abnormality. Flunarizine (23.2%) and cyproheptadine (7.5%) were the most administered prophylactic treatments. It was observed that all patients who had prophylaxis and who had come to control had a significant decrease in headaches. Conclusion: The cause of childhood headaches is mostly migraine and tension-type headache. As long as there is no abnormality in the history and neurological examination, neuroimaging studies are not required in the routine evaluation of patients with a headache. Prophylactic treatment increases the quality of life in selected cases.
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8
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van Genderen JG, Van den Hof M, Boyd AC, Caan MWA, Wit FWNM, Reiss P, Pajkrt D. Differences in location of cerebral white matter hyperintensities in children and adults living with a treated HIV infection: A retrospective cohort comparison. PLoS One 2020; 15:e0241438. [PMID: 33112914 PMCID: PMC7592958 DOI: 10.1371/journal.pone.0241438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 10/14/2020] [Indexed: 11/19/2022] Open
Abstract
Cerebral white matter hyperintensities (WMH) persist in children and adults living with HIV, despite effective combination antiretroviral therapy (cART). As age and principal routes of transmission differ between children (perinatally) and adults (behaviorally), comparing the characteristics and determinants of WMH between these populations may increase our understanding of the pathophysiology of WMH. From separate cohorts of 31 children (NOVICE) and 74 adults (AGEhIV), we cross-sectionally assessed total WMH volume and number of WMH per location (periventricular vs. deep) using fluid-attenuated inversion recovery (FLAIR) MRI images. WMH were either periventricular when within 10mm of the lateral ventricles, or deep otherwise. We assessed patient- or HIV-related determinants of total WMH volume (adjusted for intracranial volume) and location of WMH using logistic regression, while stratifying on children and adults. At enrollment, median age of participants was 13.8 years (IQR 11.4-15.9) for children and 53.4 years (IQR 48.3-60.8) for adults and 27/31 children (87%) and 74/74 adults (100%) had an HIV RNA viral load <200 copies/mL. WMH were present in 16/27 (52%) children and 74/74 adults (100%). The prevalence of deep WMH was not different between groups, (16/16 [100%] in children vs. 71/74 [96%] in adults, p = 0,999), yet periventricular WMH were more prevalent in adults (74/74 [100%]) compared to children (9/16; 56%) (p<0.001). Median WMH volume was higher in adults compared to children (1182 mm3 [425-2617] vs. 109 mm3 [61.7-625], p<0.001). In children, boys were more likely to have deep WMH compared to girls. In adults, older age was associated with higher total WMH volume, and age, hypertension and lower CD4+ T-lymphocyte nadir with a higher number of periventricular WMH. Our findings suggest that the location of WMH differs between children and adults living with HIV, hinting at a different underlying pathogenesis.
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Affiliation(s)
- Jason G. van Genderen
- Department of Pediatric Infectious Diseases, Emma Children’s Hospital,
Amsterdam UMC, University of Amsterdam, Amsterdam, The
Netherlands
| | - Malon Van den Hof
- Department of Pediatric Infectious Diseases, Emma Children’s Hospital,
Amsterdam UMC, University of Amsterdam, Amsterdam, The
Netherlands
| | - Anders C. Boyd
- HIV Monitoring Foundation, Amsterdam, The Netherlands
- Public Health Service of Amsterdam, Department of Infectious Diseases,
Amsterdam, The Netherlands
| | - Matthan W. A. Caan
- Department of Biomedical Engineering and Physics, Amsterdam UMC,
University of Amsterdam, Amsterdam, The Netherlands
- Department of Radiology, Amsterdam UMC, University of Amsterdam,
Amsterdam, The Netherlands
| | - Ferdinand W. N. M. Wit
- HIV Monitoring Foundation, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam,
The Netherlands
- Department of Global Health, Amsterdam UMC, University of Amsterdam,
Amsterdam, The Netherlands
| | - Peter Reiss
- HIV Monitoring Foundation, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam,
The Netherlands
- Department of Global Health, Amsterdam UMC, University of Amsterdam,
Amsterdam, The Netherlands
| | - Dasja Pajkrt
- Department of Pediatric Infectious Diseases, Emma Children’s Hospital,
Amsterdam UMC, University of Amsterdam, Amsterdam, The
Netherlands
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Tokatly Latzer I, Orbach R, Ben-Sira L, Mezad-Koursh D, Bachar Zipori A, Roth J, Constantini S, Fattal-Valevski A, Lubetzky R. The Clinical Utility of Inpatient Brain Magnetic Resonance Imaging in Children. J Child Neurol 2020; 35:744-752. [PMID: 32517554 DOI: 10.1177/0883073820931264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The clinical applicability and yield of brain magnetic resonance imaging (MRI) in the setting of an inpatient pediatric department has not been investigated. The authors performed a retrospective chart review of nontraumatic/nonneurosurgical children who underwent brain MRI during their hospitalization in a general pediatric department over a 5-year period. Of the 331 children who underwent brain MRI, 148 (45%) had abnormal findings. High-risk headaches and focal seizures were significantly correlated with findings on brain MRI. Diagnostic and therapeutic yields were most significant in acute demyelinating events, acute cerebrovascular disorders, high-risk headaches when supported by neurologic and ophthalmologic findings, focal seizures with evidence of multifocal epileptic activity on an electroencephalogram and ophthalmic complaints when accompanied by cranial nerve palsy and optic nerve impairment. Since the contributions of a brain MRI in hospitalized children is pivotal in specific clinical situations, a judicious decision-making process should be done before its scheduling, in order to optimize clinical care.
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Affiliation(s)
- Itay Tokatly Latzer
- Pediatric Neurology Institute, 108403Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, 26745Tel-Aviv University, Israel
| | - Rotem Orbach
- Pediatric Neurology Institute, 108403Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, 26745Tel-Aviv University, Israel
| | - Liat Ben-Sira
- Sackler School of Medicine, 26745Tel-Aviv University, Israel.,Pediatric Radiology Unit, 108403Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Daphna Mezad-Koursh
- Sackler School of Medicine, 26745Tel-Aviv University, Israel.,Pediatric Ophthalmology Unit, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Anat Bachar Zipori
- Sackler School of Medicine, 26745Tel-Aviv University, Israel.,Pediatric Ophthalmology Unit, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Jonathan Roth
- Sackler School of Medicine, 26745Tel-Aviv University, Israel.,Department of Pediatric Neurosurgery and 108403Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Shlomi Constantini
- Sackler School of Medicine, 26745Tel-Aviv University, Israel.,Department of Pediatric Neurosurgery and 108403Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Aviva Fattal-Valevski
- Pediatric Neurology Institute, 108403Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, 26745Tel-Aviv University, Israel.,These authors have contributed equally to this work
| | - Ronit Lubetzky
- Sackler School of Medicine, 26745Tel-Aviv University, Israel.,Department of Pediatrics, 108403Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.,These authors have contributed equally to this work
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10
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Abstract
This literature review provides an overview of the research using magnetic resonance imaging (MRI) in pediatric migraine and compares findings with the adult migraine literature. A literature search using PubMed was conducted using all relevant sources up to February 2019. Using MRI methods to categorize and explain pediatric migraine in comparison with adult migraine is important, in order to recognize and appreciate the differences between the two entities, both clinically and physiologically. We aim to demonstrate the differences and similarities between pediatric and adult migraine using data from white matter and gray matter structural studies, cerebral perfusion, metabolites, and functional MRI (fMRI) studies, including task-based and resting-state blood oxygen level-dependent studies. By doing this we identify areas that need further research, as well as possible areas where intervention could alter outcomes.
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11
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Hvid K, Nissen KR, Bayat A, Roos L, Grønskov K, Kessel L. Prevalence and causes of infantile nystagmus in a large population-based Danish cohort. Acta Ophthalmol 2020; 98:506-513. [PMID: 32067411 DOI: 10.1111/aos.14354] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/31/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE The aim of this study was to provide a population-based estimate on the prevalence of infantile nystagmus and to describe the causes in the Capital Region of Denmark. METHODS Review of medical records of children with infantile nystagmus born in the period 1 January 2010 through 31 December 2017 and living in the Capital Region of Denmark. We used birth registry data from Statistics Denmark and the National Danish Birth Registry to calculate the prevalence of nystagmus in children born at term and prematurely. RESULTS A total of 103 patients (52 males/51 females) with infantile nystagmus were included. The overall prevalence of infantile nystagmus was 6.1 per 10 000 live births. It was higher in premature children (28.4/10 000 live births) than children born at term (4.4/10 000), p < 0.0001, and highest in children born extremely preterm, (97.3/10 000). The most common cause of infantile nystagmus was ocular disease (44%) followed by idiopathic nystagmus (32%), neurological disorders and genetic syndromes (20%) and prematurity without retinopathy of prematurity as the only cause (4%). CONCLUSIONS In this study, we provide the prevalence of infantile nystagmus based on national medical records in which all residents are accounted for. Our findings show a prevalence of 6.1 per 10 000 live births but six times higher among children born preterm than born at term. Ocular disease was the leading cause of infantile nystagmus with albinism and ocular malformations as the most frequent. In 1/3 of patients, no cause could be identified.
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Affiliation(s)
- Karen Hvid
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kamilla Rothe Nissen
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Allan Bayat
- Danish Epilepsy Centre, Dianalund, Denmark.,Department of Pediatrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Laura Roos
- Department of Clinical Genetics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Karen Grønskov
- Department of Clinical Genetics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Line Kessel
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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12
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Pektezel MY, Konuskan B, Sonmez FM, Oguz KK, Anlar B. Pediatric headache and neuroimaging: experience of two tertiary centers. Childs Nerv Syst 2020; 36:173-177. [PMID: 31696290 DOI: 10.1007/s00381-019-04411-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Headache is a frequent complaint in children and adolescents. Decision-making for neuroimaging should take into account the cost and the need for sedation in young children. AIM To evaluate the yield of MRI in pediatric headache patients seen in two large tertiary hospitals. METHODS Data were retrospectively collected from patient records (n = 613) and neuroimaging reports. Headache was classified according to International Headache Society guidelines. RESULTS There were 346 children with imaging studies (MRI n = 281, CT n = 65). Of patients who had at least one MRI study, 29% demonstrated an abnormal finding. Findings altering the management were obtained in 21 (7%) patients: the majority (n = 17, 80%) had headache for less than 3 months. On the other hand, four patients with headache longer than 3 months (19%) and 12 patients with normal neurological examination (57%) had significant MRI results affecting management. None of the children in whom the diagnosis of migraine could be made on clinical grounds (n = 40) had a significant MRI finding. CONCLUSION Neuroimaging should be performed selectively in children with headache seen in pediatric neurology clinics, especially in headache of short duration (< 3 months) and features atypical for migraine. A normal neurological examination should not reassure the clinician.
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Affiliation(s)
- M Y Pektezel
- Department of Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - B Konuskan
- Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - F M Sonmez
- Department of Pediatric Neurology, Retired Lecturer, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
| | - K K Oguz
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - B Anlar
- Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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13
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Gutta R, Valentini KJ, Kaur G, Farooqi AA, Sivaswamy L. Management of Childhood Migraine by Headache Specialist vs Non‐Headache Specialists. Headache 2019; 59:1537-1546. [DOI: 10.1111/head.13660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Radhika Gutta
- Michigan State University School of Medicine Lansing MI USA
| | | | | | - Ahmad A. Farooqi
- Department of Pediatrics Wayne State University School of Medicine Detroit MI USA
| | - Lalitha Sivaswamy
- Department of Pediatrics at Children's Hospital of Michigan Wayne State University School of Medicine Detroit MI USA
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14
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Hadidchi S, Surento W, Lerner A, Liu CSJ, Gibbs WN, Kim PE, Shiroishi MS. Headache and Brain Tumor. Neuroimaging Clin N Am 2019; 29:291-300. [DOI: 10.1016/j.nic.2019.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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15
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Sarma A, Poussaint TY. Indications and Imaging Modality of Choice in Pediatric Headache. Neuroimaging Clin N Am 2019; 29:271-289. [PMID: 30926117 DOI: 10.1016/j.nic.2019.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pediatric headache is a common problem, with various underlying causes. Appropriate patient selection for neuroimaging is necessary to optimize the clinical evaluation. This review aims to provide a focused discussion of the clinical evaluation of children with headache, including published guidelines pertaining to neuroimaging, technical considerations for neuroimaging, and tailoring of examinations for specific clinical entities known to cause pediatric headache.
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Affiliation(s)
- Asha Sarma
- Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital, 2200 Children's Way, Suite 1421, Nashville, TN 37232-9700, USA.
| | - Tina Young Poussaint
- Department of Radiology, Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02130, USA
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16
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Sum MY, Low K, Tang PH. General anesthesia / sedation requirement influences the way MRI brain scans are ordered in a tertiary pediatric hospital. J Magn Reson Imaging 2018; 49:e250-e255. [PMID: 30390374 DOI: 10.1002/jmri.26551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/06/2018] [Accepted: 10/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND MRI guidelines have been created to help clinicians order scans appropriately. Some scans in children are carried out under general anesthesia (GA) / sedation. PURPOSE To evaluate if the requirement for GA/sedation influences the way MRI brain scans are ordered. STUDY TYPE Retrospective. POPULATION Children with MRI brain scans in 2015 to 2017. FIELD STRENGTH 3T, 1.5T. ASSESSMENT Institutional Review Board approval for waiver of consent was obtained. Clinical MRI brain reports for children were classified into whether they conformed to the American College of Radiology (ACR) 2013 guidelines by research assistants under supervision of a pediatric radiologist. Scans were sorted into those with normal brains or abnormality. STATISTICAL TEST The statistical difference between groups was assessed using t-test for continuous variables and chi-square test for categorical variables with IBM SPSS 19. RESULTS Of the total 1893 MRI scans, 431 were performed under GA and six under sedation. Of the 431 cases performed under GA/sedation, 383 (87.6%) were ordered according to guidelines. Of the 1456 cases that did not require GA/sedation, 710 (48.8%) conformed to guidelines. The percentage of scans ordered according to guidelines was 38.8% higher in those who had scans performed under GA/sedation (P < 0.001). MRI scans were normal in 635 (58.0%) out of the 1093 cases ordered according to guidelines and normal in 638 (79.8%) out of the 800 cases that did not follow guidelines. Scans not ordered according to guidelines had higher proportion of normal scans (21.8%) compared with those ordered according to guidelines (P < 0.001). DATA CONCLUSION Higher adherence to imaging guidelines is seen in younger patients who were exposed to the risks of GA/sedation for the MRI. Scans not adhering to guidelines had a higher percentage of having no brain abnormality detected. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 6 J. Magn. Reson. Imaging 2019;49:e250-e255.
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Affiliation(s)
- Min Yi Sum
- Department of Diagnostic & Interventional Imaging, KK Women's and Children's Hospital, Singapore
| | - Kathy Low
- Department of Diagnostic & Interventional Imaging, KK Women's and Children's Hospital, Singapore
| | - Phua Hwee Tang
- Department of Diagnostic & Interventional Imaging, KK Women's and Children's Hospital, Singapore
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17
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Abstract
PURPOSE OF REVIEW The goal of this review is to outline the prevalence and significance of occipital headaches in children and how they relate to neuroimaging findings. We seek to evaluate the concern that occipital headaches in children are indicative of secondary headache pathology by reviewing the yield of neuroimaging in pediatric patients with occipital headache location. RECENT FINDINGS Occipital headaches are a common presentation of primary headache disorders in children, seen in 7-16% of children presenting for evaluation of headache and in up to 20% of children diagnosed with migraine in the emergency department. Review of recent literature confirms that in and of itself, occipital location of headache in a child with recurrent headache and a normal physical examination should not be regarded as worrisome. Headaches with associated signs on neurologic examination should be investigated for a secondary cause, regardless of headache location. Occipital headaches that do not meet criteria for a primary headache disorder should be evaluated for site-specific occipital headache conditions. Neuroimaging for recurrent headache in children who have normal neurological examinations has an overall low yield (0-4.1%) for actionable findings in recent studies. Importantly, an abnormal neurologic examination often predicts the presence of neuroimaging abnormalities. In the absence of an atypical history or abnormalities on clinical examination, occipital headaches in children are no more likely to be associated with intracranial pathology than headaches in other locations. If the child's headaches are otherwise consistent with migraine or another primary headache disorder, and the neurologic examination is normal, the yield of neuroimaging is low, and imaging can generally be deferred.
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18
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Wilbur C, Yeh EA. Radiologically isolated syndrome in children: Current knowledge and future directions. Mult Scler Relat Disord 2018; 24:79-84. [PMID: 29966829 DOI: 10.1016/j.msard.2018.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/24/2018] [Accepted: 06/16/2018] [Indexed: 10/28/2022]
Abstract
As the use of magnetic resonance imaging (MRI) grows in clinical practice, clinicians are increasingly faced with the difficult task of interpreting the significance of incidental findings on brain MRI. Among individuals found to have incidental brain MRI findings, a small number have white matter abnormalities on MRI that resemble the demyelinating lesions of multiple sclerosis (MS) in the absence of a history of relevant clinical symptoms. This has been termed radiologically isolated syndrome (RIS). Recent years have seen growing interest in RIS, with observational studies that have specifically focused on answering questions regarding the subsequent risk of future clinical events and diagnosis of MS in adults and children with these findings. Given the high rate of subsequent clinical events seen in adult studies, knowledge related to RIS in children is paramount, particularly given the higher disease activity and burden in children with MS. This review examines this question, providing an overview of RIS with a focus on its significance in children including current definitions, its association with MS, and knowledge related to therapeutic interventions for RIS. We conclude with suggestions for an approach to assessment of and subsequent surveillance in children fulfilling criteria for RIS and directions for future study.
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Affiliation(s)
- Colin Wilbur
- Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - E Ann Yeh
- Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Neurosciences and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada.
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19
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ACR Appropriateness Criteria ® Headache–Child. J Am Coll Radiol 2018; 15:S78-S90. [DOI: 10.1016/j.jacr.2018.03.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 11/17/2022]
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20
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Calik M, Aktas MS, Cecen E, Piskin IE, Ayaydın H, Ornek Z, Karaca M, Solmaz A, Ay H. The association between serum vitamin B12 deficiency and tension-type headache in Turkish children. Neurol Sci 2018. [DOI: 10.1007/s10072-018-3286-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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22
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Strauss LD, Cavanaugh BA, Yun ES, Evans RW. Incidental Findings and Normal Anatomical Variants on Brain MRI in Children for Primary Headaches. Headache 2017; 57:1601-1609. [DOI: 10.1111/head.13221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 09/19/2017] [Indexed: 12/12/2022]
Affiliation(s)
| | | | - Ethan SungEun Yun
- Department of Neurology; Wake Forest Baptist Health; Winston-Salem NC USA
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Outcome and Cost of Inpatient Hospitalization for Intravenous Dihydroergotamine Treatment of Refractory Pediatric Headache. Pediatr Neurol 2017; 66:76-81. [PMID: 27847180 DOI: 10.1016/j.pediatrneurol.2016.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/08/2016] [Accepted: 09/10/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND To determine the cost and efficacy of admitting patients for intravenous dihydroergotamine treatment and to identify factors associated with a higher likelihood of response to treatment. METHODS We performed a retrospective review of all pediatric hospitalizations from 2001 to 2010 for intravenous dihydroergotamine therapy for headache. Data were collected using the REDcap database and consisted of multiple variables, including preadmission demographics, headache duration, use of prophylactic medications, inpatient therapies including dihydroergotamine dosing, procedures, consultations, total hospital cost, and headache severity at discharge and at follow-up. RESULTS Seventy-four percent of the 145 individuals who were hospitalized were female. Mean age was 14.9 years. Headache was described as chronic or daily in almost all patients and 28 (19%) had status migrainosus. Sixty-six percent had a first-degree relative with migraine. The average length of stay was 3.7 days, and the average cost was $7569 per hospitalization. Patients received an average of eight doses of dihydroergotamine. At the time of discharge, 63% of patients reported improvement. Follow-up information was available for 68% of the cohort at a median of 42 days after discharge, and 21 of 99 patients (21%) experienced sustained relief of headache. Response to dihydroergotamine was correlated with a lower rate of comorbid diagnoses, lumbar puncture, and outpatient neuroimaging. Response also correlated to less expensive hospitalizations with an average cost of $5379 per hospitalization versus $7105 per hospitalization without positive response. Response was also correlated with a patient receiving more doses of intravenous dihydroergotamine. CONCLUSIONS Although intravenous dihydroergotamine is an effective abortive medication for intractable migraine, it may provide only short-term headache relief in many pediatric patients. Hospitalization is relatively costly with only modest long-term benefit, especially in patients with chronic migraine or chronic daily headache.
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Gupta SN, Gupta VS, White AC. Spectrum of intracranial incidental findings on pediatric brain magnetic resonance imaging: What clinician should know? World J Clin Pediatr 2016; 5:262-272. [PMID: 27610341 PMCID: PMC4978618 DOI: 10.5409/wjcp.v5.i3.262] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/26/2016] [Accepted: 05/27/2016] [Indexed: 02/06/2023] Open
Abstract
Intracranial incidental findings on magnetic resonance imaging (MRI) of the brain continue to generate interest in healthy control, research, and clinical subjects. However, in clinical practice, the discovery of incidental findings acts as a “distractor”. This review is based on existing heterogeneous reports, their clinical implications, and how the results of incidental findings influence clinical management. This draws attention to the followings: (1) the prevalence of clinically significant incidental findings is low; (2) there is a lack of a systematic approach to classification; and discusses (3) how to deal with the detected incidental findings based a proposed common clinical profile. Individualized neurological care requires an active discussion regarding the need for neuroimaging. Clinical significance of incidental findings should be decided based on lesion’s neuroradiologic characteristics in the given clinical context. Available evidence suggests that the outcome of an incidentally found “serious lesion in children” is excellent. Future studies of intracranial incidental findings on pediatric brain MRI should be focused on a homogeneous population. The study should address this clinical knowledge based review powered by the statistical analyses.
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25
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Gofshteyn JS, Stephenson DJ. Diagnosis and Management of Childhood Headache. Curr Probl Pediatr Adolesc Health Care 2016; 46:36-51. [PMID: 26750538 DOI: 10.1016/j.cppeds.2015.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
Abstract
Headache is one of the most common chief complaints seen in the pediatrician's office. Oftentimes, identifying the etiology of headache and differentiating primary and secondary causes can present a diagnostic conundrum. Understanding the most common causes of primary and secondary headache is vital to making a correct diagnosis. Here we review the typical presentations of the most common primary headache disorders and the approach to evaluation of the pediatric patient presenting with headache. Diagnostic workup, including the key features to elicit on physical examination, when to order head imaging, and the use of other ancillary tests, is discussed. Current treatment modalities and their indications are reviewed. We will also describe some of the new, emerging therapies that may alter the way we manage headache in the pediatric population. Headache can, at times, be a frustrating symptom seen in the pediatrician's office, but here we hope to better elucidate the approach to evaluation, management, and treatment as well as provide some hope in regards to more effective upcoming therapies.
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Affiliation(s)
| | - Donna J Stephenson
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA.
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Sweeney ML, Kukreja M, Horn PS, Standridge SM. Diagnoses in Pediatric Patients With Magnetic Resonance Imaging (MRI) Lesions Suspicious for Demyelination. J Child Neurol 2015; 30:1651-7. [PMID: 25862736 DOI: 10.1177/0883073815578522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 02/08/2015] [Indexed: 11/16/2022]
Abstract
Magnetic resonance imaging (MRI) studies of the brain in pediatric patients frequently show abnormal white matter lesions, which may be concerning for demyelinating disease. This study aimed to determine the proportion of pediatric patients who have MRI lesions concerning for demyelinating disease at presentation and ultimately are diagnosed with a primary central nervous system demyelinating disease. A retrospective chart review was performed on MRI reports of patients who underwent imaging evaluation at a single tertiary pediatric hospital. Of 299 patients identified, 192 presented with acute neurologic complaints. In this group, ≥ 5 discrete lesions, African American race, and having brain stem, thalamic, cerebellar, or optic nerve lesions was associated with the patient being diagnosed with a disease that required further treatment. The other 107 patients underwent MRI for other indications. Among these subjects, having lesions within the corpus callosum or cerebellum was associated with being diagnosed with a disease requiring further treatment.
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Affiliation(s)
- Michael L Sweeney
- Department of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Marcia Kukreja
- Department of Radiology, Texas Children's Hospital, Houston, TX, USA
| | - Paul S Horn
- Department of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shannon M Standridge
- Department of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Komazaki Y, Fujiwara T, Ogawa T, Sato M, Suzuki K, Yamagata Z, Moriyama K. Association between malocclusion and headache among 12- to 15-year-old adolescents: a population-based study. Community Dent Oral Epidemiol 2014; 42:572-80. [PMID: 24954448 DOI: 10.1111/cdoe.12111] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 05/02/2014] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Headaches are a common problem among adolescents, and malocclusion is a possible risk factor. The purpose of this study was to investigate the association between malocclusion and headache among Japanese adolescents aged 12-15 years using a population-based sample. METHODS A total of 938 adolescents (94.7% of the target population in Koshu City) participated. A modified version of the Index of Orthodontic Treatment Need (IOTN) was used by orthodontists to evaluate occlusal characteristics, and the frequency of headaches (none, rarely, sometimes) was assessed via questionnaire (N = 938). Ordered logistic regression analyses were used to analyze the association between malocclusion and headache. RESULTS The prevalence of malocclusion diagnosed using the modified version of the IOTN was 44.9%. Multiple ordered logistic regression analyses showed that the odds ratio (OR) of having malocclusion for headache was 1.38 (95% confidence interval [CI]: 1.06-1.80), after adjustment for demographics, lifestyle, and dental status including orthodontic treatment history and tooth size. Moreover, among occlusal traits, lower crowding was independently associated with headache (OR: 1.64, 95% CI: 1.07-2.51). CONCLUSIONS We found that malocclusion, especially lower crowding, was associated with headache in a population-based sample of adolescents aged 12-15 years in Japan. Further study is needed to elucidate the mechanisms by which malocclusion affects headache.
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Affiliation(s)
- Yuko Komazaki
- Section of Maxillofacial Orthognathics Department of Maxillofacial Reconstruction and Function, Division of Maxillofacial/Neck Reconstruction, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan
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