Evolution of brain glucose metabolism with age in epileptic infants, children and adolescents.

During the first years of life, the human brain undergoes repetitive modifications in its anatomical, functional, and synaptic construction to reach the complex functional organization of the adult central nervous system. As an attempt to gain further insight in those maturation processes, the evolution of cerebral metabolic activity was investigated as a function of age in epileptic infants, children and adolescents. The regional cerebral metabolic rates for glucose (rCMRGlc) were measured with positron emission tomography (PET) in 60 patients aged from 6 weeks to 19 years, who were affected by complex partial epilepsy.

Demyelinating hereditary neuropathies in children: a morphometric and ultrastructural study.

Twenty-three cases of hereditary demyelinating neuropathies are reported, 13 with different types of hereditary motor and sensory neuropathy (HMSN) and 9 with globoid cell or meta-chromatic leucodystrophies. Ultrastructural and morpho-metric studies showed some critical pathological features emphasizing: 1) the variability of the recessive forms of HMSN; 2) the morphological distinction between HMSN type I and type III; and 3) differences between these types of HMSN and other "onion bulb" neuropathies such as those found in leucodystrophies, which account for distinct underlying mechanisms.

Brain glucose utilisation in acquired childhood aphasia associated with a sylvian arachnoid cyst: recovery after shunting as demonstrated by PET.

Regional brain glucose utilisation was investigated with PET and fluorodeoxyglucose (FDG) in a case of epileptic aphasia (Landau-Kleffner syndrome) associated with a left sylvian arachnoid cyst. CT and MRI had failed to disclose any mass effect of the cyst on surrounding brain structures. Sequential metabolic measurements showed a comparable pronounced hypometabolism in cortical regions around the cyst, involving speech areas, and suggested mild but chronic compression of the developing brain.

Effects of body position on sleep related disordered breathing in a patient with Steinert's disease.

Sudden changes in respiratory patterns observed during polysomnographic studies may suggest a positional form of SAHS (sleep apnea-hypopnea syndrome). We report the case of a 37-year-old patient with Steinert's disease with this form of SAHS. Breathing during sleep could be regularized by a simple positional control.

Nonprogressive type II hereditary sensory autonomic neuropathy: a homogeneous clinicopathologic entity.

Two different clinical subtypes were previously identified within hereditary sensory autonomic neuropathy (HSAN) type II: a stable congenital form and a progressive one. This paper discusses two clinicopathologic cases of nonprogressive HSAN type II with morphometric correlations. In addition, a retrospective literature search was carried out to locate other cases where an accurate histologic examination, including ultrastructural features, was available in order to relate clinical and pathologic aspects of the disease.

A disorder of axonal development, necrotizing myopathy, cardiomyopathy, and cataracts: a new familial disease.

We report severe congenital encephalopathy and profound hypotonia associated with necrotizing myopathy, cardiomyopathy, and cataracts in 3 infants, including 2 sisters. Brain scans suggested agenesis of the corpus callosum. Neuropathological findings consisted of severe atrophy of the corpus callosum (not the usual agenesis with longitudinal callosal bundles), atrophy of the white matter, and absence of pyramidal tracts in the medulla.

Distal infantile spinal muscular atrophy associated with paralysis of the diaphragm: a variant of infantile spinal muscular atrophy.

We report the clinical, electrophysiological, and morphological observations of five infants with an unusual form of spinal muscular atrophy (SMA). In these infants muscular weakness and atrophy were initially restricted to the distal limbs and this pattern was associated with paralysis of the diaphragm. The difference between the clinical manifestations of this syndrome and the classical form of infantile spinal muscular atrophy (SMA type 1) as well as other congenital hereditary neuropathies is discussed.

Familial dysautonomia in a non-Jewish girl, with histological evidence of progression in the sural nerve.

A case of typical familial dysautonomia (HSN, type III) in a non-Jewish girl is reported. The number of unmyelinated fibres was found to be reduced and sural nerve biopsy showed evidence of past axonal degeneration. There was also marked endoneurial fibrosis and a lack of the largest myelinated fibres.

Morphometric studies of normal sural nerves in children.

Quantitative histologic studies of biopsies of normal sural nerves were performed on nine children aged 4 days to 17 years. Stereologic computerized procedures were used to determine total endoneurial area, size distribution and number of myelinated, unmyelinated fibers and Schwann cell nuclei per nerve and per square millimeter, and the ratio of myelin thickness to axonal diameter. There was an inverse linear relationship between the number of myelinated fibers per square millimeter and increasing age.

Congenital neuropathy with prevailing axonal changes. A clinical and histological report.

A case of congenital neuropathy associated with an unclassified chronic brain disorder is described. Morphological findings differ from the reported congenital neuropathies where primary myelin change have been usually found. In contrast, sural nerve biopsy showed marked signs of active or past axonal degeneration; at the teasing and morphometric analysis there was also some evidence of segmental demyelination.

Hereditary motor and sensory neuropathies (HMSN). Retinal involvement and ERG alterations.

Hereditary motor and sensory neuropathies (HMSN) is a complex group of diseases, mainly of unknown etiology. In 1975, Dyck proposed a classification based essentially on the type of hereditary transmission, nerve conduction velocity and histologic aspect of small nerve biopsies. Hagberg & Westerberg (1983) proposed a new classification.

Abnormalities of muscle fibers in maple syrup urine disease.

Muscle fiber abnormalities are described in three cases of neonatal maple syrup disease. There were important variations in fiber diameters. Lesions consisted in focal or diffuse destruction of myofibrils.

[Sultopride, treatment of choice for psychomotor agitation in severe encephalopathy. 33 cases in a neuropediatric milieu].

Thirty-three patients showing a definite group of symptoms including chiefly agitation or self-mutilation often dramatic have been treated with sultopride at doses ranging from 7 to 50 mg/kg/day at the Institut Médico-Pédagogique de l'Enfant-Jésus at Ciney. Forty-eight per cent showing this particular symptoms have been cured or greatly improved with sultopride. In 36% the response was incomplete in that it appeared to be identical with sultopride solely or with the previous medications.

Congenital hypomyelination polyneuropathy. Pathological findings compared with polyneuropathies starting later in life.

Biopsies from patients with congenital hypomyelination polyneuropathy (Group I) and with late infantile (Group II) and juvenile (Group III) forms of hereditary motor and sensory neuropathy (HMSN) type III were compared, using morphometric methods and ultrastructural analysis. In congenital polyneuropathies (Group I), myelin sheaths were practically absent and onion bulbs, essentially made of multiple laminae of double layered basement membrane, surrounded every axon in the size range of normal myelinated axons. The number of these axons was markedly reduced.

[Mononeuritis multiplex in a case of primary macroglobulinemia (author's transl)].

A case of Waldenström's disease with peripheral nerve involvement resembling mononeuritis multiplex is described. The various etiopathogenic mechanisms generally cited in connection with peripheral neuropathies observed in cases of macroglobulinemia, most often of the polyneuritic type, are discussed in turn : nerve infiltration by lymphocytes, intervention of an immunologic mechanism through the agency of paraprotein links with amyloidosis. However, the reported case differs from habitual cases on account of the asymmetry of the nerve involvement and the discovery of vasculitic lesions on muscle biopsy.

Aqueductal stenosis in X-linked hydrocephalus: a secondary phenomenon?

Two cases of x-linked hydrocephalus are reported. One underwent postmortem examination: serial sections of the brain stem failed to show stenosis of the aqueduct, the mean and minimal cross-sectional areas of which were normal. However, there were some morphological changes which were compatible with a mechanical compression of the brain stem.

Uncommon case of type II glycogenosis.

The authors report an uncommon case of type II glycogenosis. An 8-year-old boy developed a slow progressive myopathy. Biopsy of skeletal muscle showed scarce lesions under the optic microscope but in 50% of the fibers the presence of vacuoles filled with glycogen under the electron microscope.

Hyaline membrane disease: prognostic factors and medium-term follow-up.

One hundred and twenty two cases of severe hyaline membrane disease are reported. 68 of them survived (57%). Adverse clinical, radiological and laboratory factors, and their effects on the early mortality rate, are analysed with particular reference to the referring centers, delay in admission, transport and the critical state of most infants on admission.