[Analysis of clinical and imaging features of 6 cases of linear scleroderma en coup de sabre with central nervous system involvement in children]

Objective: To summarize the clinical and imaging features of linear scleroderma en coup de saber (LSCS) with central nervous system involvement in children. Methods: The clinical data(clinical manifestations and imaging features) of 6 children diagnosed with LSCS with central nervous system involvement who were admitted to Beijing Children's Hospital Affiliated to Capital Medical University from May 2019 to November 2021 were retrospectively analyzed. Results: The 6 patients were all female, aged 6.8 (3.3, 11.0) years at the time of diagnosis, and aged 3.0 (1.7, 4.1) years at the time of discovery of facial skin lesions. Facial skin lesions appeared before neurological symptoms in 5 cases, and neurological symptoms appeared 2 months before skin lesions in 1 case. All the patients had "sword wound" skin lesions on the forehead with alopecia. Neurological manifestations included epileptic seizures in 6 cases, focal neurological defects in 5 cases, and headaches in 2 cases. The intracranial lesions were all ipsilateral to the skin lesions. The magnetic resonance imaging (MRI) of 6 cases showed abnormal signals mainly involving white matter in 1 hemisphere, and 3 cases showed local encephalomalacia. The scattered low signal was observed in 5 cases on susceptibility weighted imaging. Localized brain parenchyma or leptomeninges enhancement was seen on Gadolinium-enhanced sequences in 5 cases. Scattered foci of calcification on the affected side were seen on cranial CT in 4 cases. Skin biopsy was performed in 2 cases. Part of the lesion of the brain was removed in 1 case, and the pathological findings suggested small vasculitis, which was consistent with skin pathological changes. All patients received symptomatic treatment with antiepileptic drugs. Oral prednisone combined with methotrexate was given in 4 cases, and 1 case was given oral prednisone only. One case was presumed to be in the resting stage of the disease due to significant cerebral atrophy in half of the brain, and only antiepileptic drugs were added. The patients were followed up for 6-36 months. The skin lesions of scleroderma and alopecia did not progress in 5 cases, and hemifacial atrophy was developed in 1 case, which was considered to be combined with Parry-Romberg syndrome. The seizures were controlled in 4 cases. One case had reduced seizure frequency but left hemiplegia. One patient still had intractable epilepsy and paroxysmal headache. Conclusions: LSCS with central nervous system involvement is more common in girls, with seizures and neurological defects as the main manifestations. Intracranial lesions are mostly ipsilateral to the skin lesions. Cerebral microbleeds, calcification, and encephalomalacia foci are common, and the pathological changes in skin and intracranial lesions are consistent with small-vessel vasculitis. Prednisone combined with methotrexate treatment has shown some efficacy, but some children remain with refractory epilepsy and neurological deficit symptoms.

Screening of Risk Factors for Poor Prognosis in Patients with Refractory Epilepsy Secondary to Encephalomalacia

Objective

The study was aimed at screening the independent prognostic risk factors for refractory epilepsy associated with encephalomalacia (REAE).

Methods

Patients with REAE treated in the First People's Hospital of Linping District from January 2018 to December 2019 were selected. The prognosis was represented by Engel grading. Clinical data of the patients were collected, including age, sex, BMI, lesion sites, number of lesion sites, lesion size, seizure frequency, epilepsy type, and treatment methods. Independent risk factors for poor prognosis were screened by logistic regression analysis. The receiver operating characteristic curve (ROC) was used to evaluate the prognostic efficacy of independent risk factors.

Results

A total of 48 patients were included in this study, including 31 patients (64.58%) in the good prognosis group and 17 patients (35.42%) in the poor prognosis group. The mean age of the poor prognosis group was higher than that of the good prognosis group (P = 0.002). The proportion of patients with multisite lesions in the poor prognosis group was higher than that in the good prognosis group (P = 0.016). The proportion of patients with cerebral malacia lesion diameter ≥ 3 cm in the poor prognosis group was higher than that in the good prognosis group (P = 0.002). The proportion of patients with attack frequency ≥ 2 times/month in the poor prognosis group was higher than in the good prognosis group (P = 0.002). The proportion of patients receiving surgical treatment in the poor prognosis group was lower than that in the good prognosis group (P < 0.001). Age, number of lesion sites, size of encephalomalacia, and seizure frequency were independent risk factors for the prognosis of patients with REAE (OR > 1, P < 0.05). Surgical treatment was an independent protective factor associated with the prognosis of patients with REAE (OR < 1, P < 0.05). The area under the ROC curve of surgical treatment was 0.83 (P = 0.004). The area under the ROC curve of the size of encephalomalacia was 0.72 (P = 0.008). There was a positive correlation between age and size of encephalomalacia and Engel grade (r > 0, P < 0.05). Surgical treatment was negatively correlated with Engel grade (r < 0, P < 0.05). The number of lesion sites and seizure frequency had no significant correlation with Engel (P > 0.05). The proportion of Engel I patients treated with surgery was higher than that treated with drugs (P = 0.001). The ratio of Engel III and IV patients treated with surgery was lower than that treated with medications (P < 0.05).

Conclusion

Age, number of lesion sites, size of encephalomalacia, and seizure frequency are independent risk factors for the prognosis of patients with REAE. Surgical treatment is an independent prognostic factor for patients with REAE. Surgical treatment can significantly improve patient outcomes.

The Relationship Between Prenatal Porencephaly and the Encephalomalacias of Early Life

In the course of time the term “porencephaly” has come to mean a condition characterized by any large circumscribed defect in the substance of the brain. Because of the unmyelinated state of the centrum semiovale in early life traumatic, vascular, anoxic or infective processes are likely to lead to a much more massive resorption of the tissues than occurs in the adult. Parts of the wall of the hemisphere may be converted into a semi-translucent membrane separating the lateral ventricle from the sub-arachnoid space. This thin sheet of neuroglial tissue usually represents the residual stretched out molecular layer of the cortex, and is a finding common to many varieties of infantile and foetal encephalomalacia (Wolf and Cowan, 1956).

The investigation of homovanillic acid in the human brain and its correlation to senile dementia

In a previous investigation, the concentration of homovanillic acid (HVA) seemed to be related to the degree of dementia (Gottfries et al., 1965). The object of the present work is the further study of the occurrence of HVA in the human brain, especially with regard to senile dementia. The hypothesis is that senile dementia is a disease with a disturbance in the monoamine metabolism, which is reflected in a reduction of HVA in the neostriatum.