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Abstract
RATIONALE It is widely believed that structural abnormalities of the brain contribute to the pathophysiology of schizophrenia. The parietal lobe is a central hub of multisensory integration, and abnormities in this region might account for the clinical features of schizophrenia. However, few cases of parietal encephalomalacia associated with schizophrenia have been described. PATIENT CONCERNS AND DIAGNOSES In this paper, we present a case of a 25-year-old schizophrenia patient with abnormal parietal encephalomalacia. The patient had poor nutrition and frequently had upper respiratory infections during childhood and adolescence. She showed severe schizophrenic symptoms such as visual hallucinations for 2 years. After examining all her possible medical conditions, we found that the patient had a lesion consistent with the diagnosis of encephalomalacia in her right parietal lobe and slight brain atrophy. INTERVENTIONS The patient was prescribed olanzapine (10 mg per day). OUTCOMES Her symptoms significantly improved after antipsychotic treatment and were still well controlled 1 year later. LESSONS This case suggested that parietal encephalomalacia, which might be caused by inflammatory and infectious conditions in early life and be aggravated by undernutrition, might be implicated in the etiology of schizophrenia.
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Affiliation(s)
- Fen Pan
- Department of Mental Health, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Mental Disorder's Management, Zhejiang Province
| | - Jun-Yuan Wang
- Department of Mental Health, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Mental Disorder's Management, Zhejiang Province
- The School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yi Xu
- Department of Mental Health, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Mental Disorder's Management, Zhejiang Province
| | - Man-Li Huang
- Department of Mental Health, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Mental Disorder's Management, Zhejiang Province
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Ono H. [A successful new liposteroid therapy for West syndrome in polycystic encephalopathy]. No To Hattatsu 2008; 40:405-407. [PMID: 18807891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Low C, Garzon E, Carrete H, Vilanova LC, Yacubian EMT, Sakamoto AC. Early destructive lesions in the developing brain: clinical and electrographic correlates. Arq Neuropsiquiatr 2008; 65:416-22. [PMID: 17665007 DOI: 10.1590/s0004-282x2007000300010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Accepted: 02/09/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Early brain insults can cause cavitary lesions including porencephaly (POR) and multicystic encephalopathy (MCE). The objective of this study was to investigate clinical and electrographic correlates associated to these types of destructive brain lesions. METHOD Patients with POR and MCE were selected and submitted to clinical and Video-EEG monitoring. The following variables were analyzed: demographic data, type of lesion, presence of gliosis, perinatal complications, epilepsy, brain atrophy, and presence and frequency of epileptiform discharges. RESULTS Twenty patients were included, 65% males, 35% females, ages ranging from 1 to 40 years, 14 with MCE and 6 with POR. Eighteen patients had hemiparesis, 19 had epilepsy (current or in the past), seven of them had refractory seizures, and 16 had epileptiform discharges. All patients with MCE had gliosis while only 2 with POR had it. CONCLUSIONS No correlation was observed between type of lesion and clinical and electrographical outcome. However, a positive correlation was observed between frequency of discharges and presence of brain atrophy, and between MCE and gliosis.
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Affiliation(s)
- Cristiane Low
- UNIPETE - Unidade de Pesquisa e Tratamento das Epilepsias - Departamento de Neurologia e Neurocirurgia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Saie DJ, Sills ES. Hyperprolactinemia presenting with encephalomalacia-associated seizure disorder and infertility: a novel application for bromocriptine therapy in reproductive endocrinology. Neuro Endocrinol Lett 2005; 26:533-5. [PMID: 16264405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Accepted: 08/10/2005] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To describe successful oral bromocriptine therapy for hyperprolactinemia accompanied by seizure disorder and encephalomalacia identified during infertility evaluation. MATERIALS & METHODS A 32 year-old male with an unspecified seizure disorder was referred for infertility consultation. The initial seizure was at age 12, and was treated sequentially with phenytoin, phenobarbitol, and carbamazepine monotherapy which was maintained for six years and then discontinued. At age 26, a second seizure was experienced and 150mg lamotrigine b.i.d. was initiated. When the patient married it was discovered that erection was impossible; tadalafil was administered without success. At our center, total testosterone was low at 107ng/dl and semen analysis revealed oligoasthenozoospermia. Serum prolactin was 79.3ng/ml; visual field examination was normal. Brain MR showed no pituitary enlargement. However, encephalomalacia of the right occiptal lobe with porencephalic dilation of the occipital horn of the right lateral ventricle was present. RESULTS The patient was initially placed on 2.5mg/d bromocriptine but after three months only a nominal reduction of serum prolactin was achieved. Serum prolactin normalized (25.4ng/ml) after bromocriptine was increased to 7.5mg/d. Repeat semen analysis showed overall sperm concentration of 85M/ml, 30% motility and 12% normal forms morphology (Kruger strict criteria). Total testosterone level was 191ng/dl after final bromocriptine dose was attained, which was well tolerated. DISCUSSION Bromocriptine has an established role in the management of hyperprolactinemia, particularly in women. For males with elevated serum prolactin even when associated with focal encephalomalacia and seizure disorder, bromocriptine therapy can offer safe benefits including improved semen parameters and normal serum testosterone levels.
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Affiliation(s)
- David John Saie
- St. Christopher's College of Medicine, Luton, Bedfordshire, United Kingdom
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Abstract
Polioencephalomalacia in general and the specific disorders associated with lead toxicosis and sodium imbalances all have commonalities in risk groups and clinical presentations but can be differentiated based on herd history, subtle clinical differences, and diagnostic tests. Treatment also has some overlap, but determining the specific etiology enables more specific treatment and more effective prophylactic measures.
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Affiliation(s)
- Christopher K Cebra
- Large Animal Internal Medicine, College of Veterinary Medicine, Oregon State University, Corvallis, OR 97331, USA.
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Affiliation(s)
- Deborah Levine
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA.
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Mariani CL, Platt SR, Newell SM, Terrell SP, Chrisman CL, Clemmons RM. Magnetic resonance imaging of cerebral cortical necrosis (polioencephalomalacia) in a dog. Vet Radiol Ultrasound 2001; 42:524-31. [PMID: 11768520 DOI: 10.1111/j.1740-8261.2001.tb00981.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A 3-year-old neutered female mixed breed dog was examined because of severe, generalized seizure activity, tetraparesis, and encephalopathic signs. Cerebrospinal fluid (CSF) evaluation was unremarkable except for a mild increase in protein. Serum and CSF titers for infectious diseases were negative. Magnetic resonance (MR) imaging examination of the brain was performed and lesions were found within the cerebral gray matter of the temporal and parietal lobes. The lesions had increased signal intensity on T1, T2, and proton density-weighted images. There was mild inhomogeneous enhancement following intravenous contrast medium administration. Neurologic status improved and the seizures were well controlled, but the dog never regained normal mentation and euthanasia was performed 10 weeks after initial evaluation. At necropsy, severe cerebral cortical necrosis was found in the regions corresponding to the lesions seen on MR imaging examination. Large numbers of fat-containing macrophages (gitter cells) were found within these areas, and are thought to be responsible for the characteristic hyperintensity seen on the MR images.
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Affiliation(s)
- C L Mariani
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Health Science Center, University of Florida, Gainesville 32610-0126, USA
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Abstract
The authors present the case of a 68-year-old man who experienced acute obstructive hydrocephalus after having suffered an infarction in the occipital lobe. Histopathological and serial neuroimaging examinations revealed that portions of a large disintegrating occipital infarct had entered the lateral ventricle and obstructed the passage of cerebrospinal fluid (CSF). Ventricular drainage was performed for 2 weeks until the patient's hydrocephalus resolved. The CSF initially contained a high concentration of protein (1070 mg/dl), a high leukocyte count of 115 cells/mm3, and a rich fibrinous exudate. Findings in the present case indicate that collapse of a periventricular ischemic lesion into the ventricles may sometimes occur not only after cerebral hemorrhage but also after cerebral infarction.
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Affiliation(s)
- H Nakaguchi
- Department of Neurosurgery, Suwa Central Hospital, Chino City, Nagano, Japan.
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Abstract
OBJECTIVE The purpose of this study was to determine long-term outcomes among pregnancies complicated by twin-twin transfusion syndrome and treated in a tertiary center with serial aggressive amnioreduction. STUDY DESIGN Thirty-three pregnancies with a diagnosis of twin-twin transfusion syndrome were treated with > or =1 amnioreduction. The perinatal outcome was assessed according to 15 parameters, whereas the main outcome at age > or =2 years was the absence of cerebral palsy. RESULTS Gestational age at diagnosis ranged from 14.5 to 33 weeks' gestation (median, 20.6 weeks' gestation), whereas gestational age at delivery was between 18.5 and 37 weeks' gestation (median, 30.5 weeks' gestation). The number of amnioreductions per pregnancy ranged from 1 to 15 (median, 2). At initial examination hydrops of the recipient and absence of the end-diastolic velocity of the umbilical artery in one of the twins were associated with poor prognosis. Fifty-one (77%) twins were born alive. At 24 months after birth both infants from 57% of the pregnancies (19/33) were alive, whereas at least one infant from 70% of the pregnancies (23/33) was alive. Thirty-three infants (78% of the survivors) were older than 36 months at last follow-up. Cerebral palsy was diagnosed in 2 of 42 infants (4.7%). One of the affected infants was born after the fetal death of the cotwin; the other infant was born with congenital cardiac malformations. CONCLUSIONS In the group of fetuses in which both twins were delivered alive after 27 weeks' gestation without congenital malformations and survived the neonatal period, no major neurologic handicaps developed in any of the infants. At initial examination both hydrops of the recipient and absence of end-diastolic flow velocity waveforms of the umbilical artery in one of the twins were poor prognostic signs.
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Affiliation(s)
- G Mari
- Department of Obstetrics and Gynecology and the Division of Maternal-Fetal Medicine, Yale University School of Medicine, New Haven, CT, USA
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Cohen O, Biran I, Steiner I. Cerebrospinal fluid oligoclonal IgG bands in patients with spinal arteriovenous malformation and structural central nervous system lesions. Arch Neurol 2000; 57:553-7. [PMID: 10768631 DOI: 10.1001/archneur.57.4.553] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To investigate the incidence and characteristics of patients with structural central nervous system (CNS) lesions and cerebrospinal fluid oligoclonal IgG bands. DESIGN A retrospective study. METHOD The medical records of patients with cerebrospinal fluid oligoclonal IgG bands were evaluated for the presence of structural CNS lesions, their location and cause, and for clinical characteristics. SETTING Cerebrospinal fluid oligoclonal IgG bands were examined in the Neuroimmunology Laboratory, Hadassah University Hospital, Jerusalem, Israel. PATIENTS Two hundred seventy of 570 patients with positive cerebrospinal fluid oligoclonal IgG bands were available for analysis. Twenty patients had structural CNS lesions. RESULTS Twenty (7.5%) of the 270 patients had structural CNS lesions: 3 patients had spinal arteriovenous malformation; 5 patients had tumors; 9 patients had compressive cervical myelopathy. Traumatic leukomalacia, Arnold-Chiari malformation type 1, and CNS hemosiderosis were present in 1 patient each. In 2 patients (1 patient with recurrent meningioma and 1 patient with posttraumatic encephalomalacia) the presence of a structural CNS lesion was followed by the development of multiple sclerosis. In all 3 patients with spinal arteriovenous malformation, oligoclonal IgG identification prolonged the time to diagnosis and therapy, which varied from a few weeks to 3 years. CONCLUSIONS Structural CNS lesions, responsible for the neurological disorder, were present in 20 patients (7.5%) with cerebrospinal fluid oligoclonal IgG bands. The mechanism underlying oligoclonal IgG presence in spinal arteriovenous malformation and the coexistence of multiple sclerosis and structural CNS lesions is unknown, but may be related to recurrent tissue damage with repeated presentation of CNS antigens to the immune system.
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Affiliation(s)
- O Cohen
- Department of Neurology, Hadassah University Hospital, Jerusalem, Israel
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Andermann F, Cukiert A, Olivier A. Excellent surgical results obtained in patients with a depressed frontal fracture leading to frontal encephalomalacia and intractable frontal seizures. Epilepsia 1998; 39:108. [PMID: 9578021 DOI: 10.1111/j.1528-1157.1998.tb01282.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mottron L, Mineau S, Décarie JC, Jambaqué I, Labrecque R, Pépin JP, Aroichane M. Visual agnosia with bilateral temporo-occipital brain lesions in a child with autistic disorder: a case study. Dev Med Child Neurol 1997; 39:699-705. [PMID: 9352734 DOI: 10.1111/j.1469-8749.1997.tb07367.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A 2-year-old boy meeting the criteria for autistic disorder was diagnosed 2 years later with a visual agnosia characterised by a combination of certain aspects of associative and apperceptive agnosia. MRI then revealed a severe encephalomalacia of the right temporal lobe and bilateral temporo-occipital areas. This association is discussed in terms of a clinical and aetiological relation between autistic disorder and visual agnosia.
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Affiliation(s)
- L Mottron
- Service de Recherche, Hôpital Rivière-des-Prairies, Montréal, Québec, Canada
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Abstract
BACKGROUND--Patients with seizures may have abnormal brain imaging. Lesions demonstrated on computerized tomography or magnetic resonance imaging often suggest the underlying cause of the seizures, and may prompt an invasive investigation for diagnosis and treatment. In an increasingly recognized subset of patients however, the imaged lesions spontaneously resolve. While poorly understood, these 'disappearing' lesions may in fact be the consequence of seizures, rather than the cause. Two patients with 'disappearing' lesions are presented: the first patient had a proven cause, the second a probable one. Case 1. A patient with new onset seizures had an abnormal MRI. An angiogram confirmed thrombosis of the straight sinus. On follow-up, she was doing well; repeat imaging was normal with resolution of the lesion. Case 2. A patient with a long seizure history had been well controlled on medications, and had no change in frequency of her seizures. She was found to have a left homonymous hemianopsia. MRI revealed a right parieto-occipital lesion. The patient refused further work-up and was lost to follow-up. She returned almost a year later; repeat imaging was normal. CONCLUSION--Patients with seizures and abnormal imaging suggestive of structural lesions may occasionally have lesions that resolve spontaneously. While some diagnoses remain elusive, an important consideration to exclude in these patients is venous thrombosis.
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Affiliation(s)
- T H Rao
- Department of Neurology, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, New York, USA
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Herman TE, Siegel MJ. Special imaging casebook. Congenital disseminated herpes simplex infection with visceral calcifications. J Perinatol 1994; 14:80-2. [PMID: 8169684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- T E Herman
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110
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Abstract
Cranial magnetic resonance imaging (MRI) was performed prospectively in 45 children (ages 3-27 months) with clinically documented motor delay to evaluate the ability of MRI to determine etiologic factors, to determine whether myelination correlated with motor delay, and whether the clinical category corresponded with the imaging findings. Of the 22 children diagnosed clinically as having major motor delay (i.e., cerebral palsy), 77% had magnetic resonance imaging abnormalities. In 23%, etiologic associations were established from MRI alone and in 32% a clinically suspected etiology was supported. No children had myelination delay as the sole abnormality. In 23 children with minor motor delay, only 17% had abnormal scans. Clearly, MRI provided useful information in the majority of children with cerebral palsy; therefore, a classification system is proposed in which MRI can be used in conjunction with clinical assessment to specify more precisely the etiologic factors in cerebral palsy.
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Affiliation(s)
- E J Candy
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Lajarrige C, Adafer M, Yassine B, Atallah W, Mouthemy G, Klink R, Khoury M, Bouhelier P, Kremp L. [Multicystic encephalomalacia in a surviving twin after death of the other twin in utero]. Ann Pediatr (Paris) 1993; 40:37-40. [PMID: 8442644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A case of multicystic encephalomalacia in a twin is reported. The other twin died in utero at 32 weeks gestational age. Because there was no evidence of fetal distress the pregnancy was allowed to continue until 36 weeks gestational age. Injuries to the surviving twin due to disseminated intravascular coagulation (DIVC) and vascular thrombosis or to anoxia and ischemia may occur when there are anastomoses between the circulatory systems of the two twins, i.e., in monochorionic pregnancies. The classically recommended strategy is to wait for adequate maturity of the surviving fetus (36 weeks). It is suggested that this attitude may be overly expectant and may deserve reappraisal.
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Affiliation(s)
- C Lajarrige
- Service de Pédiatrie, Centre Hospitalier Général, Laon
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Farrell MA, DeRosa MJ, Curran JG, Secor DL, Cornford ME, Comair YG, Peacock WJ, Shields WD, Vinters HV. Neuropathologic findings in cortical resections (including hemispherectomies) performed for the treatment of intractable childhood epilepsy. Acta Neuropathol 1992; 83:246-59. [PMID: 1557956 DOI: 10.1007/bf00296786] [Citation(s) in RCA: 137] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Despite the use of hemispherectomy in the treatment of medically refractory seizures since the early 1950's, few studies published have documented neuropathologic findings in the resected specimens. This report describes the neuropathologic findings in 38 children who underwent either hemispherectomy or multilobar cortical resection as treatment for medically intractable epilepsy between 1986 and 1990. Examination of the resected specimens revealed a variety of abnormalities which fell into four broad categories. Malformations or hamartomatous lesions were the dominant finding in 15 patients, whereas encephalomalacic lesions were the most prominent abnormality in 16; chronic pathogen-free encephalitits (Rasmussen's encephalitis) was present in 3 and an additional 3 children had Sturge-Weber-Dimitri syndrome. There were no gross or microscopic abnormalities in 1 patient. This report provides the first comprehensive description of the pathologic findings in a series of children with refractory epilepsy of varying types treated by hemispherectomy-multilobar resection.
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Affiliation(s)
- M A Farrell
- Department of Pathology, UCLA Medical Center 90024
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Abstract
Isolated dystonia of trunk and neck muscles without involvement elsewhere has been termed segmental axial dystonia--a rare disorder. We report a 31-year-old man who developed marked dystonia of paraspinal muscles and progressive scoliosis 6 months after a closed head injury. Computed tomography (CT) disclosed three small areas of encephalomalacia, one involving the head of the caudate nucleus. Treatment with trihexyphenidyl resulted in significant improvement of the dystonia and scoliosis.
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Affiliation(s)
- B Jabbari
- Neurology Service, Walter Reed Army Medical Center, Washington, D.C. 20307-5001
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Keohane C, Robain O, Ponsot G, Gray F. Cerebral lymphoma and HIV encephalitis in a case of paediatric AIDS, with pre-existing multicystic encephalomalacia. Ir J Med Sci 1991; 160:179-82. [PMID: 1752741 DOI: 10.1007/bf02961668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A case of intracerebral malignant B cell lymphoma associated with encephalitis typical of Human Immunodeficiency Virus (HIV) infection is described in a 4 year old child, with post-transfusion Acquired Immune Deficiency Syndrome (AIDS) and severe pre-existing cystic encephalomalacia. This report further documents B cell lymphoma as the commonest cause of an intracerebral mass, and an important cause of death in paediatric AIDS. That more than one pathological process may be responsible for neurological symptoms in paediatric AIDS is also emphasised.
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Abstract
Growing skull fractures indicate underlying brain damage which is an important aetiological factor in their development. Two cases of growing skull fractures managed successfully with shunt surgery are presented. In one, the growing skull fracture was associated with an underlying tense occipital porencephalic cyst and in the other with cystic encephalomalacia and hydrocephalus. Following shunt surgery, signs of raised intracranial pressure were relieved, improvement in neurological status was noted, regrowth of the bone edges was seen and major surgery including brain debridement was avoided. The role of shunt surgery in growing skull fractures in infants is discussed and relevant details highlighted.
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Affiliation(s)
- R R Sharma
- Department of Neurosurgery, Khoula Hospital, Muscat, Sultanate of Oman
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Abstract
In a 4 1/2-year period, 4 of 68 children in a longitudinal study of neurological complications of human immunodeficiency virus (HIV) infection had clinical and/or neuroradiological evidence of stroke, yielding a clinical incidence of stroke in this population of 1.3% per year. During this period, 32 subjects died, and permission for autopsy was granted in 18 of the patients, including 3 of 4 who had clinical evidence of stroke. The prevalence of cerebrovascular pathological features in our consecutive autopsy series was higher than the clinical incidence. At autopsy cerebrovascular disease was documented in 6 (24%) of 25 children with HIV infection, including all 3 children who had clinical evidence of stroke. Four patients had intracerebral hemorrhages, 6 patients had nonhemorrhagic infarcts, and 3 had both. Hemorrhage was catastrophic in 1 child and clinically silent in 3 children, all of whom had immune thrombocytopenia. One child had an arteriopathy that affected meningocerebral arteries. In another child, the arteries of the circle of Willis were aneurysmally dilated. Two children had coexisting cardiomyopathy and subacute necrotizing encephalomyelopathy with vascular proliferation. These results suggest that stroke should be considered when children with HIV infection develop focal neurological signs.
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Affiliation(s)
- Y D Park
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461
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Low JA, Froese AF, Galbraith RS, Sauerbrei EE, McKinven JP, Karchmar EJ. The association of fetal and newborn metabolic acidosis with severe periventricular leukomalacia in the preterm newborn. Am J Obstet Gynecol 1990; 162:977-81; discussion 981-2. [PMID: 2183620 DOI: 10.1016/0002-9378(90)91299-r] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
One hundred twenty preterm newborns less than 34 weeks' gestational age have been studied prospectively to determine the frequency of fetal and newborn metabolic acidosis and to examine the relationship of metabolic acidosis to periventricular leukomalacia as demonstrated by serial newborn ultrasonographic examinations. Fetal metabolic acidosis, based on an umbilical artery buffer base less than 34 mmol/L at delivery, occurred in three cases (2%), one of which had evidence of periventricular leukomalacia. Newborn metabolic acidosis that is based on a buffer base less than 34 mmol/L during the 4 days after delivery occurred in 12 cases (10%), five of which had evidence of periventricular leukomalacia. There is a significant relationship between the degree and duration of newborn metabolic acidosis and the occurrence of periventricular leukomalacia. This study indicates that systemic metabolic acidosis is an important pathophysiologic marker of periventricular leukomalacia. Intrapartum fetal asphyxia with metabolic acidosis, although an infrequent occurrence in the preterm newborn, may account for a few cases of periventricular leukomalacia, while the more common newborn metabolic acidosis, when of sufficient degree and duration, carries a high risk of periventricular leukomalacia.
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Affiliation(s)
- J A Low
- Department of Obstetrics and Gynaecology, Queen's University, Kingston, Ontario, Canada
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Sans Fito A, Campistol Plana J, Poo Argüelles P, Krauel Vidal J. [Multicystic encephalomalacia in twin pregnancies]. An Esp Pediatr 1990; 32:163-6. [PMID: 2189324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Multicystic encephalomalacia (ME) is a rare entity in the pediatric age. In ME brain tissue in substituted by cavities of variable size. ME has different etiologies being asphyxia and circulatory alterations the most important factors. In monozygotic twins there is an increased incidence of structural anomalies than dizygotic twins. We present four twin patients with ME. Three of them had a prenatal dead sibling. The fourth pair of twins had a twin-twin transfusion. We want to stress the utility of brain echography in early diagnosis of ME.
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Affiliation(s)
- A Sans Fito
- Servicio de Neurología, Hospital Infantil San Juan de Dios, Barcelona
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Alexianu M, Tudorache B, Podani M. The importance of cerebral lesions of vascular origin in the morphopathologic picture of old age dementia. Neurol Psychiatr (Bucur) 1989; 27:133-45. [PMID: 2781230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Our study refers to the complex neuropathologic examination of 70 demented patients (40 males and 30 females) above 60 years of age. Proportion of different types of cerebral damage with vascular pathogeny showed that 78% of the vascular dementia cases had as morphological background various aspects of multi-infarct dementia; softenings of variable size and lacunae, associated or not with myelinic rarefactions and pallor specific to subcortical arteriosclerotic encephalopathy; the remaining cases pointed to single anoxic lesion and/or subcortical encephalopathy. Perfect clinico-morphological diagnostic concordance has not always been reached in our sample--as in literature cases--often due to the dementia subtypes overlapping, and to the fact that the same clinical syndrome may show in different cerebral lesions. Likewise, no correlation has been found between lesion type, site or size and clinical picture or dementia course, which was also reported by other authors. On a morphopathogenic basis, we support the view that necrotic lesions of ischemic origin--multi-infarct and lacunar dementias--should be distinguished from myelinic rarefactions and pallor in the white matter, whose pathogeny is still controversial. Due attention is paid to the importance of the venous factor in the development of subcortical encephalopathy.
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Abstract
The brain pathology in very prematurely born infants with intraventricular hemorrhage (IVH) was studied particularly as to the severity and site of the complicated brain lesions responsible for the prognosis. A high frequency of leukomalacia, pontosubicular necrosis and/or olivocerebellar neuronal loss was found in the cases of IVH, and these non-hemorrhagic brain lesions showed an increasing frequency with the grade of IVH. However, there was marked reduction of IVH, periventricular leukomalacia and, in particular, brainstem lesions in prematurely born cases of sudden infant death. These IVH and associated conditions have different pathogenesis, but factors responsible for their occurrence may be present together in each case.
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Affiliation(s)
- S Takashima
- Division of Mental Retardation and Birth Defect Research, National Institute of Neuroscience, Tokyo, Japan
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28
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Ogino T, Kanda Y, Kawakita A, Yamaguchi N, Futamura M, Goto H. Ultrasonographic findings in periventricular leukomalacia in the newborn: two cases associated with early onset group B streptococcal sepsis. Acta Paediatr Jpn 1988; 30:89-93. [PMID: 3148267 DOI: 10.1111/j.1442-200x.1988.tb02503.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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29
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Bogousslavsky J, Regli F. [Cerebral microangiopathies, lacunae and leuko-araiosis]. Schweiz Rundsch Med Prax 1987; 76:1318-25. [PMID: 3321337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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30
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Fiore PM, Cangemi FE, Epstein LG. Unusual ocular findings in multicystic encephalomalacia. Am J Ophthalmol 1987; 104:436-7. [PMID: 3661661 DOI: 10.1016/0002-9394(87)90248-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- P M Fiore
- Department of Ophthalmology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark 07103
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31
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Connell J, Oozeer R, Regev R, De Vries LS, Dubowitz LM, Dubowitz V. Continuous four-channel EEG monitoring in the evaluation of echodense ultrasound lesions and cystic leucomalacia. Arch Dis Child 1987; 62:1019-24. [PMID: 3314719 PMCID: PMC1778682 DOI: 10.1136/adc.62.10.1019] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Continuous monitoring by electroencephalography (EEG) was performed in 31 preterm infants with echodense ultrasound lesions using the Oxford Medilog four channel recorder. In 12 infants these densities preceded cyst formation, eight in the periventricular and four in the subcortical region. In the 19 other infants the densities resolved. The most severe EEG depression occurred in the four infants with subcortical cysts, who also had the poorest outcome. Six of eight infants with periventricular lesions had lesser degrees of abnormality though all infants had moderate to severe handicap at follow up. Similar abnormalities were seen on EEG recording in three infants in whom the densities resolved without cyst formation and these infants also had an abnormal outcome. An abnormal EEG recording provides a sensitive early guide to the severity and prognosis of these lesions, even before they can be seen on ultrasonography.
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Affiliation(s)
- J Connell
- Department of Paediatrics and Neonatal Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London
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32
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Vlahovitch B, Reynaud C, Verger AC, Rhiati G, Mansour H, Hammoud F. [Value of neurosurgery in pseudotumor encephalomalacia]. Agressologie 1987; 28:383-6. [PMID: 3618901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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33
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Peet RL, Gaynor W. Encephalomalacia in maned wolves (Chrysocyon brachyurus) associated with possible disseminated intravascular coagulation syndrome. Aust Vet J 1987; 64:59. [PMID: 3606507 DOI: 10.1111/j.1751-0813.1987.tb16132.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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34
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Abstract
During an 18 month period, 120 preterm infants of 34 weeks' gestation or less were prospectively examined for periventricular leucomalacia (PVL) by cerebral ultrasound. Neurological and developmental assessment was carried out at 18 months of age corrected for prematurity in 82 surviving neonates. The developmental outcome (Griffiths development quotient) was above 80 and similar in infants with normal scans (n = 41), isolated periventricular-intraventricular haemorrhage (n = 13), and post-haemorrhagic hydrocephalus (n = 4), and no major handicap was diagnosed in these groups. By contrast, the prognosis was variable and poorer in infants with PVL (n = 24) and depended on the extent and site of the lesion. Infants with frontal PVL (n = 13) developed normally. Major sequelae (n = 8) were closely related to frontal-parietal PVL and frontal-parietal-occipital PVL and could be ascribed to the presence of cysts as well as to a persistent hyperechogenic ultrasonographic PVL appearance. A relation between size and site of the lesion and type and severity of the handicap was established.
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35
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White CB, Bass JW. Low CSF glucose and high protein levels in neonatal herpes simplex meningoencephalitis. J Pediatr 1986; 109:911-3. [PMID: 3772673 DOI: 10.1016/s0022-3476(86)80734-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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36
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Stazi C, Carpinteri F, Stazi F. [Stroke: from its etiology to its therapy]. Clin Ter 1986; 118:433-47. [PMID: 3536272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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37
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Budashevskiĭ BG, Balashov AN. [Decerebrate rigidity in craniocerebral injuries (clinico-statistical analysis]. Zh Vopr Neirokhir Im N N Burdenko 1986:14-9. [PMID: 3766002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Decerebrate rigidity (DR) is encountered in 12% of cases with craniocerebral trauma. Statistically significant prevalence of DR in brain compression is shown. Examination of 131 patients with traumatic DR revealed the location of the lesion and the causes of brain compression which led to DR most frequently. The authors distinguish a group of clinico-laboratory signs which have diagnostic and prognostic importance in these patients.
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38
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Simonati A, Laverda AM, Rizzuto N. Multicystic encephalomalacia associated with symmetrical necrotizing brain stem lesions in an infant: a case report. Clin Neuropathol 1986; 5:139-45. [PMID: 3757345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The simultaneous occurrence of multicystic encephalomalacia of the cerebral hemispheres, and symmetric necrotizing lesions of diencephalic and infratentorial structures is described in a 15 month-old infant. The baby developed clonic jerks of four limbs a few hours after delivery. She attained no developmental milestones, and remained bed-ridden with hypertonic posture until her death. Multicystic cavities of the cerebral hemispheres were well evident at CT scan when she was 7 months old. The topographic distributions of the different pathological pictures are described; their relationship to the regional properties of the developing brain are commented upon. Etiological aspects of this case are discussed according to present knowledge of the pathophysiological mechanisms leading either to multiple cyst formation or to necrotizing lesions.
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39
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Abstract
The brains of 50 consecutively admitted infants weighing 1250 g or less at birth were serially examined beyond the neonatal period for periventricular haemorrhage and for periventricular leukomalacia with real-time ultrasound. There was significant correlation between the presence or absence and the severity of haemorrhage with survival. A prospective neurodevelopmental assessment was completed at 2 years of age, corrected for prematurity, on all survivors. None of the 20 survivors with normal scans or germinal layer haemorrhages had evidence of major disability and all four survivors with intracerebral haemorrhage or periventricular leukomalacia had major disability. The mental performance on the Bayley scales of infant development was also significantly worse in the latter group. Six of the eight survivors with intraventricular haemorrhage had no major disability, including three who had post-haemorrhagic hydrocephalus. Our results showed that cerebral ultrasound detection of brain pathology is a good predictor of neurodevelopmental outcome in such extremely low birthweight infants. However, as the maximum extent of periventricular haemorrhage may develop beyond one week of age and cystic periventricular leukomalacia commonly develops after the neonatal period, serial scanning is mandatory to ensure diagnostic accuracy for both periventricular haemorrhage and leukomalacia.
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40
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41
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Gupta RK, Pant CS, Singh AK, Behl P. Real time ultrasonography in the evaluation of hydrocephalus and associated abnormalities. Indian Pediatr 1986; 23:249-54. [PMID: 3527967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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42
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de Vries LS, Barth PG, Dubowitz LM. [Periventricular leukomalacia in premature newborn infants; a frequently occurring cerebral complication and an echographic diagnosis]. Ned Tijdschr Geneeskd 1986; 130:24-7. [PMID: 3513025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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43
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Abstract
The utility of real-time sonography in the diagnosis of neonatal periventricular leukomalacia (PVL) has been described only recently. Six cases are reported of PVL diagnosed by serial real-time scanning. The sonographic findings were correlated with the computed tomographic findings and the clinical history. In five of six infants in whom scanning was performed, characteristic multiseptated periventricular cavitations developed 2-3 weeks after birth or later. A transition from normal to increased periventricular echogenicity was often observed before the development of the periventricular cavitations in nonhemorrhagic PVL. The parenchymal abnormality demonstrated by sonography correlated well with an abnormal neurologic outcome. It is suggested that serial real-time scanning be performed in neonates whose history suggests the possibility of hypoxic-ischemic brain injury. Nonspecific predictors of PVL include seizures, apnea, disturbed mental status, abnormal muscle tone, and leg weakness.
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44
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 15-1985. Cardiopulmonary arrest in a 14-year-old girl. N Engl J Med 1985; 312:976-83. [PMID: 3883184 DOI: 10.1056/NEJM198504113121508] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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45
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Abstract
Multiple cysts in both hemispheres were detected in four children under 1 year of age by real-time sonographic sector scanning. These cysts, typical of multiple cystic encephalomalacia, followed viral encephalitis in two, bacterial meningitis in one, and bacterial meningitis superimposed on intracerebral hemorrhage in one. The diagnosis of multiple cystic encephalomalacia, which has a grave prognosis, is readily made with high-resolution real-time sonography.
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46
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Abstract
Two cases of radiographically isodense subdural hematoma are presented in which absence of displacement of midline cerebral structures was due not to bilateral lesions, but rather to "balancing" of the volumetric effect of a unilateral lesion by preexisting encephalomalacia. Attention to the past medical history and the computed tomography scan which showed evidence of unilateral loss of brain substance led to the proper diagnosis.
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47
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48
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Provinciali L, Marchesi GF, Signorino M, Pasquini U. [Effect of risk factors on the site and development of stroke]. Minerva Med 1982; 73:2717-22. [PMID: 7133483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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49
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Belloni AR, Gallo P, Neri Serneri L, Bozzao L. [Cerebro-bulbo-spinal disconnection or "locked-in syndrome"]. Recenti Prog Med 1982; 73:380-96. [PMID: 6760270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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50
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Ionel C, Onaca P, Gheorghiu M. [Clinico-anatomical study in hemorrhagic cerebral infarct]. Rev Med Interna Neurol Psihiatr Neurochir Dermatovenerol Neurol Psihiatr Neurochir 1982; 27:109-17. [PMID: 6216565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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