The open opercular sign: diagnosis and significance

Four children with varying clinical manifestations, but with the unifying feature of severe developmental delay, had bilateral enlargement of the sylvian fissure confirmed by magnetic resonance imaging (MRI). Subsequently, we examined 125 consecutive MRI scans of the heads of pediatric patients, looking for this insular exposure, and did not find it. Pathological correlation in 1 child revealed arhinencephaly and abnormal gyral formation; another is known to have migrational abnormalities. We suggest that the open operculum is a sign of arrested development and is associated with other anomalies and a poor prognosis.

Polymicrogyria: a case detected by MRI

We report a 3-year-old child affected by severe encephalopathy, partial seizures with early onset and microgyria whom polymicrogyria was detected by means of magnetic resonance imaging (MRI). We believe that MRI first allow an early and confident in vivo diagnosis of this severe and probably not so rare condition.

A variant of Fukuyama congenital muscular dystrophy in a non-Japanese child

We report a case of Fukuyama congenital muscular dystrophy with inflammatory infiltrate on muscle biopsy in an American girl of non-Japanese ancestry. The child was hypotonic, had decreased muscle strength in all extremities, and poor head control. Her mental and motor development were delayed. She developed generalized seizures at 19 months of age. Her muscle enzymes were abnormal; cranial computed tomography demonstrated hypoplasia of the cerebellum. Electromyogram was normal. Deltoid muscle biopsy documented scattered basophilic regenerating myofibers and focal atrophic fibers with focal increases of endomysial connective tissue, small endomysial foci of inflammatory cells, and occasional perimysial, perivenular lymphocytic infiltrates. Prednisone therapy produced some decrease in serum muscle enzyme levels.

Congenital muscular dystrophy and cerebral CT scan anomalies. Results of a collaborative study of the Société de Neurologie Infantile

We present the results of a collaborative study on the association of congenital muscular dystrophy with central nervous system anomalies revealed by CT scan investigation of 10 patients. In seven children, an abnormal hypodensity of the cerebral white matter is found; in four of these patients, this radiological anomaly is either isolated, or associated with a moderate intellectual impairment; in one case, severe mental retardation and ocular changes had occurred; in the other two cases, the muscular disease was progressing slowly, in association with microcephaly, epilepsy, and moderate mental retardation. Three children were afflicted with a severe early encephalopathy and congenital muscular dystrophy, and presented signs of cortical and subcortical atrophy on CT scan. Two of these patients corresponded to different types of cerebro-ocular dysplasia-muscular dystrophy syndromes, and the third patient of Fukuyama's congenital muscular dystrophy. These observations are discussed and compared with those reported in the literature. The authors emphasize the need to investigate possible cerebral CT scan anomalies in congenital muscular dystrophies, and to look for muscular changes in some prenatal encephalopathies.

The health and educational status of adolescents with congenital rubella syndrome

As part of a longitudinal study of children with congenital rubella syndrome, 53 adolescents between 16 and 18 years of age were surveyed to determine their health and educational status. The findings were compared with those at the 18-months evaluation. At 16 to 18 years neurosensory impairments, cerebral dysfunction and organic behaviour syndromes were predominant, but the majority of children had multiple handicaps. A higher proportion had hearing loss. Although all the hearing-impaired children were begun in oral-based educational programs, 90 per cent of those with severe to profound hearing-loss diagnosed before the age of 18 months had changed to total or manual communication. Those with mild to moderate hearing-loss diagnosed after 18 months primarily communicate orally. The educational implications of these findings are discussed.

Effects of hyperphenylalaninemia in the fetal stage on the postnatal development of fetal rat brain

The effect of exposure at different prenatal stages to maternal hyperphenylalaninemia (HyPhe) on the somatic and neurological development of fetuses in rats was studied, with special respect to the change of relevant enzyme activities in the brain. While evident somatic damage was found only in the fetuses exposed to maternal HyPhe at a last stage of gestation, distinct mental retardation seemingly due to some irreversible damage to the brain was observed in all the treated fetuses regardless of the timing of exposure, and a significantly reduced activity of 2', 3'-cyclic nucleotide 3'-phosphohydrolase (CNPase), a marker enzyme of myelin, was confirmed in the mantle region of the brain.

Neonatal alloimmune thrombocytopenic purpura and congenital porencephaly in two siblings associated with a "new" maternal antiplatelet antibody

We report a brother and sister, both of whom have porencephaly, hydrocephalus, optic atrophy, severe mental retardation, and spastic quadriplegia. In the younger child, abnormal intracranial structure was demonstrated by sonography at 32 weeks' gestation and was suspected earlier. Both children had transient severe thrombocytopenia as newborns. The mother is healthy and has never had purpura or other bleeding symptoms. However, her serum was found to react strongly with platelets from the father and from both children. The antibody in the mother's serum is platelet-specific but does not appear to be directed against any of the known antigens associated with neonatal alloimmune thrombocytopenic purpura (NATP) in other families, including PlA1, PlE2, or Baka. Although the mother's serum reacts with platelets from all 47 unrelated normal donors tested and from both the mothers and the fathers of 17 other children with suspected NATP, it does not react with her own platelets or with platelets from a patient with Glanzmann's thrombasthenia. These observations suggest that the serum from this woman identifies a previously undescribed high-frequency platelet-specific alloantigen and that sensitization to this determinant caused severe immune thrombocytopenia in both her children. It is likely that this led to intracranial hemorrhage in utero in these cases.

[Encephalocraniocutaneous lipomatosis and linear naevus sebaceus]

Encephalocraniocutaneous lipomatosis is a rare neurocutaneous dysgenetic syndrome, which is characterized by unilateral lipomas in the subcutis of the face, skalp and skull, porencephalic cyst of the ipsilateral hemisphere, epilepsy, and severely delayed development. Furthermore a variety of skin lesions (choristomas) has been described. In the present case the skin lesions had the form of a linear nevus sebaceus. This condition is frequently combined with epilepsy and neurological disorders (Schimmelpenning-Feuerstein-Mims-syndrome). The latter seems not to be a very rare syndrome. The coincidence of characteristics of both syndromes in the same child supports the suggestion of a pathogenetical relationship.

Maternal and congenital rubella

Although it is certainly a childhood dis ease, many a pediatrician completes his resi dency having seen none or only a few cases of typical rubella. Despite this lack of ex perience he is likely to be invited by an internist or obstetrician to see a patient (often pregnant) with possible rubella or who has been exposed to the disease. On the advice of the consulting pediatrician, the pregnancy may be terminated or may be allowed to go to completion. In the latter case, he may eventually be called upon to evaluate the infant for evidence of con genital rubella.

To handle such a situation intelligently, it is necessary to have a thorough under standing of the clinical features and epi demiology of postnatal rubella, the special circumstances involved with infection of mother and fetus, and the current status of methods for diagnosis, treatment, and pre vetition of infection.