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Gburek-Augustat J, Sorge I, Stange M, Kern J, Merkenschlager A, Nägele T, Krägeloh-Mann I. Acute and Chronic Kernicterus: MR Imaging Evolution of Globus Pallidus Signal Change during Childhood. AJNR Am J Neuroradiol 2023; 44:1090-1095. [PMID: 37620154 PMCID: PMC10494954 DOI: 10.3174/ajnr.a7948] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/25/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND AND PURPOSE Despite its rarity in Western countries, kernicterus resulting from severe neonatal hyperbilirubinemia and its associated neurologic consequences still persists. Subtle MR imaging patterns may be overlooked, leading to diagnostic and prognostic uncertainties. The study systematically analyzes MR imaging pattern over time. MATERIALS AND METHODS A retrospective MR imaging study was conducted in Departments of Pediatric Neurology at the University Children's Hospitals in Leipzig, Germany, or Tübingen, Germany, between 2012 and 2022 in patients who presented beyond the neonatal period suspected of having chronic kernicterus. RESULTS Eight patients with a total of 15 MR images were identified. The clinical diagnosis of kernicterus was confirmed in all cases on the basis of typical MR imaging findings: Bilateral, diffuse hyperintensity of the globus pallidus was observed in the neonatal period on T1WI (1 MR imaging, at 2 weeks), in infancy on T2WI (4 MR images, at 9-26 months). In children 2 years of age and older, bilateral hyperintensity on T2WI was limited to the borders of the globus pallidus (8 MR images, at 20 months -13 years). Notably, 2 children exhibited normal initial MR imaging findings at 2 months of age. Hence, MR imaging depiction of kernicterus pathology evolves with time, first evident on T1WI, subsequently on T2WI, with a "blind window" during early infancy. The T2WI signal change initially involves the entire globus pallidus and later is limited to the borders. Kernicterus had not been diagnosed in any except 2 patients by previous investigators. CONCLUSIONS All patients presented with a characteristic clinical history and signs and an evolving MR imaging pattern. Nonetheless, the diagnosis of kernicterus was frequently missed. Abnormalities on later MR images appear to be underrecognized.
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Affiliation(s)
- J Gburek-Augustat
- From the Division of Neuropaediatrics (J.G.-A., A.M.), Hospital for Children and Adolescents, University Hospital Leipzig, Leipzig, Germany
| | - I Sorge
- Department of Pediatric Radiology (I.S.), University Hospital for Children and Adolescents, University Leipzig, Germany
| | - M Stange
- Department of Pediatrics (M.S.), University Hospital Halle, Halle, Germany
| | - J Kern
- Department of Paediatric Neurology (J.K., I.K.-M.), University Children's Hospital, Tübingen, Germany
| | - A Merkenschlager
- From the Division of Neuropaediatrics (J.G.-A., A.M.), Hospital for Children and Adolescents, University Hospital Leipzig, Leipzig, Germany
| | - T Nägele
- Department of Diagnostic and Interventional Neuroradiology (T.N.), Tübingen University Hospital, Tübingen, Germany
| | - I Krägeloh-Mann
- Department of Paediatric Neurology (J.K., I.K.-M.), University Children's Hospital, Tübingen, Germany
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Schulze M, Groeschel S, Gburek-Augustat J, Nägele T, Horger M. [Lysosomal storage diseases]. ROFO-FORTSCHR RONTG 2015; 187:1057-60. [PMID: 26609772 DOI: 10.1055/s-0035-1552368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lang N, Esser W, Evers S, Kellinghaus C, Nguento A, Schlegel U, Gaida B, Gburek-Augustat J, Altenmüller DM, Burghaus L, Hoffmann F, Fiedler B, Bast T, Rehfeld T, Happe S, Seitz RJ, Boor R, Stephani U. Intravenous levetiracetam in clinical practice--Results from an independent registry. Seizure 2015; 29:109-13. [PMID: 26076852 DOI: 10.1016/j.seizure.2015.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 03/06/2015] [Accepted: 03/26/2015] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Most common clinical studies with antiepileptic drugs do not reflect medical everyday practice due to their strict in- and exclusion criteria and specifications of treatment regimens. Here we present a large non-interventional registry with the intention to evaluate the spectrum of applications in daily use and the efficacy and tolerability of intravenously given levetiracetam (LEV-iv). METHODS In a prospective approach of 17 neurological and neuropediatric centres in Germany LEV-iv treated patients of all ages were included over a period of 10 months. The observational period was 10 days with daily documentation of LEV-iv administration, type and frequency of seizures, currently used drugs and doses, and adverse events (AEs). In addition, treatment efficacy and tolerability were assessed by patients and physicians at study end as well as practicability of LEV-iv using a five-step scale. RESULTS In 95 patients LEV-iv was administered, 93 were included into the analysis. The median LEV-iv dose was 1500 mg (range 110-6000 mg) per day. Median age was 66 years (range 0.7-90.3 years). The majority of patients (n=70, 75%) suffered from status epilepticus (SE, n=55, 59%) and acute seizure clusters (n=15, 16%). Of those with SE, 41 patients (75%) had SE for the first time. Acute seizure clusters and SE terminated in 83% after LEV-iv administration. A total of 29 adverse events were reported in 17 of the 95 patients from the safety set. Ten of these were at least possibly related to LEV-iv treatment. Slight decrease of blood pressure during the infusion (3 patients each) was captured most frequently. No serious side effect was observed. Physicians rated the efficacy and tolerability of LEV-iv treatment as good or very good in 78% and 82% of the cases, respectively. CONCLUSION In this large observational study of everyday practise the use of LEV-iv exhibited a remarkable good response and tolerability in patients with acute onset seizures (mostly SE). Further randomized controlled studies, like the established status epilepticus trial (ESET) are needed to confirm these findings.
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Affiliation(s)
- N Lang
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - W Esser
- Department of Neurology, Städtisches Klinikum, Karlsruhe, Germany
| | - S Evers
- Department of Neurology, Lindenbrunn Hospital, Coppenbrügge, Germany
| | - C Kellinghaus
- Department of Neurology, Klinikum, Osnabrück, Germany
| | - A Nguento
- Department of Neurology, Asklepios Klinikum Uckermark, Schwedt, Germany
| | - U Schlegel
- Department of Neurology, Ruhr University, Bochum, Germany
| | - B Gaida
- Department of Neurology, University Hospital, Greifswald, Germany
| | - J Gburek-Augustat
- Department of Neuropediatrics, University Hospital, Tübingen, Germany
| | | | - L Burghaus
- Department of Neurology, University Hospital, Köln, Germany
| | - F Hoffmann
- Department of Neurology, Krankenhaus Martha-Maria, Halle, Germany
| | - B Fiedler
- Department of Neuropediatrics, University Hospital, Münster, Germany
| | - T Bast
- University Children's Hopsital, Heidelberg, Germany
| | - T Rehfeld
- Department of Neurology, Dietrich Bonhoeffer Klinikum, Neubrandenburg, Germany
| | - S Happe
- Department of Neurology, Klinik Maria Frieden, Telgte, Germany
| | - R J Seitz
- Department of Neurology, University Hospital, Düsseldorf, Germany
| | - R Boor
- Northern German Epilepsy Centre for Children and Adolescents, Raisdorf, Germany
| | - U Stephani
- Department of Neuropediatrics, University Hospital Schleswig-Holstein, Kiel, Germany.
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