Neurocutaneous Disorders in Pregnancy.

Importance: Neurocutaneous disorders have significant implications for care of the pregnant patient. As neurocutaneous disorders are uncommon, obstetricians may be unfamiliar with these disorders and with recommendations for appropriate care of this population.

Objective: This review aims to summarize existing literature on the interaction between neurocutaneous disorders and pregnancy and to provide a guide for physicians caring for an affected patient.

Hereditary Neuropathy With Liability to Pressure Palsy Detected During the Use of Recreational Drugs.

Nitrous oxide (NO) has been an increasingly popular recreational drug over the past few years. Abuse is associated with severe neurological complications and even fatal outcomes. Here we present a case of chronic nitric oxide abuse in a teenager presenting with rapidly progressive mixed sensory and motor polyneuropathy.

Yield of Neurodiagnostic Testing in Children Presenting to a Pediatric Emergency Department With Altered Mental Status.

Background: Emergency department (ED) visits for altered mental status (AMS) in children are common. Neuroimaging is often performed to ascertain etiology, but its utility has not been well studied. Our objective is to describe the yield of neuroimaging studies in children who present to an ED with AMS.

Pediatric Resident Confidence in Assessing Neurological Cases: A Nationwide Survey.

Background: A relative shortage of pediatric neurologists in proportion to estimated neurological disorders often results in general pediatricians evaluating and treating children with complex neurological conditions. Dedicated rotations in pediatric neurology are not mandated during medical school or pediatric residency. We evaluated the perceptions of a large cohort of pediatric residents and program directors (PDs) regarding child neurology training.

An Atypical Radiologic Presentation of Right Sixth Lateral Rectus Palsy: A Case Report.

Isolated ocular palsies are often associated with a benign process in the pediatric population but early diagnosis is critical to exclude any serious pathology. In this case, a six-year-old female with no significant past medical history presented with isolated right-eye medial deviation. The patient reported right-eye medial deviation for the past several weeks and associated double vision, but denied any pain with eye movements, other cranial nerve changes, or headaches.

Neurological Effects of COVID-19 in Children.

The COVID-19 pandemic has spread rapidly across the world in 2020, affecting both adults and, to a lesser extent, children. In this article, the authors describe the neurologic manifestations of COVID-19 in children, including the epidemiology, pathogenesis, clinical features, laboratory and imaging findings, and treatment options. The management of patients with concomitant neuroimmunologic disorders and drug interactions between medications used to treat COVID-19 and other neurologic disorders (especially immune-modifying drugs) is also discussed.

Children With Complex Febrile Seizures: Is Hospital Admission Necessary?

Children with complex febrile seizure (CFS) are often hospitalized for concerns for serious bacterial infection (SBI) or seizure recurrence. We describe the yield of diagnostic studies and seizure recurrence during hospitalization in CFS children. We performed a retrospective review of 372 visits in 350 developmentally normal children aged 6 to 60 months between 2011 and 2016 for CFS.

Factors Predisposing to Post Dural Puncture Headache in Children.

Background: Knowledge of the factors that predispose to postdural puncture headache in children may help reduce the occurrence of this complication.

Materials And Methods: A retrospective cohort study of children who presented to the study institution between 2010 and 2018 was conducted. Children were divided into 2 groups: those who experienced postdural puncture headache and those who did not.

Effectiveness of Standard Combination Therapy in Pediatric Migraine.

Background: A combination of parenteral medications (often referred to as standard combination therapy) is frequently used in the treatment of acute migraine in the pediatric emergency department (PED). The primary aim of this study was to evaluate the two-hour, 24-hour, and seven-day impact of one such regimen on pain in children who present to the PED. Standard combination therapy for purposes of our study is defined as a bolus of intravenous saline, and a combination of intravenous ketorolac, prochlorperazine, and diphenhydramine.

Diagnosing Pseudotumor Cerebri: An Age-based Approach.

Investigators from Hillel-Yaffe, Carmel, and Bnai Zion Medical Centers in Israel studied the comparative clinical presentations and predisposing factors for idiopathic intracranial hypertension (IIH) across age groups.

Quality of Life in Multiple Sclerosis.

Investigators from Karolinska Institute in Stockholm, Sweden report on their findings comparing quality of life (QoL) measures in both pediatric-onset multiple sclerosis (POMS) and adult-onset multiple sclerosis (AOM).

Rapid Sequence MRI Protocol in the Evaluation of Pediatric Brain Attacks.

Background: The objective of our study was to evaluate the clinical utility of rapid sequence magnetic resonance imaging (MRI) utilizing diffusion-weighted imaging and fluid-attenuated inversion recovery sequences in children with acute ischemic strokes and nonstroke brain attacks.

Methods: We performed a retrospective chart review of patients aged one month to 25 years for whom a pediatric stroke clinical pathway was activated. Diffusion-weighted imaging and fluid-attenuated inversion recovery were obtained followed by a complete MRI.

Reversible Cerebral Vasoconstriction Syndrome and Sickle Cell Disease: A Case Report.

Reversible cerebral vasoconstriction syndrome (RCVS), is rare in the pediatric population and is characterized by severe headaches and other neurologic symptoms. We present a case of RCVS occurring concomitantly with posterior reversible encephalopathy syndrome in an 8-year-old African American child with sickle cell disease (HbSS). Imaging studies including computed tomography, magnetic resonance imaging and cerebral angiography of the brain showed acute hemorrhagic stroke and a beaded appearance of peripheral cerebral vessels.

Management of Childhood Migraine by Headache Specialist vs Non-Headache Specialists.

Objective: This study aims to compare the management practices of a headache specialist with non-headache specialists in the treatment of children with migraine. The use of appropriate rescue medications and prophylactic agents, application of neuroimaging, and short-term outcomes are compared in children treated by the two groups of physicians.

Methods: A retrospective cohort study was conducted by utilizing the electronic medical records of children 3-18 years of age with migraine, who were evaluated at a tertiary care children's hospital from 2016 to 2018.

Utility of Neuroimaging in Children Presenting to a Pediatric Emergency Department With Ataxia.

Objectives: The aim of this study was to evaluate the utility of neuroimaging in children who present to the pediatric emergency department with acute-/subacute-onset ataxia. Neuroimaging is performed in many children with ataxia to rule out serious intracranial pathology. There is, however, limited evidence to support such practice.

Functional Neurologic Symptom Disorder in Children: Clinical Features, Diagnostic Investigations, and Outcomes at a Tertiary Care Children's Hospital.

Objective: To describe the presenting symptoms and short-term outcomes of children diagnosed with functional neurologic symptom disorder and to compare the demographic and clinical characteristics of children who received neurodiagnostic testing to those who did not.

Study Design: Single center, retrospective review of 222 children who presented to the emergency department of a children's hospital, and diagnosed with functional neurologic symptom disorder, between 2010 and 2015.

Results: Out of 222 visits (females = 156, African Americans = 130, mean age = 13.

Life-Threatening Headaches in Children: Clinical Approach and Therapeutic Options.

Life-threatening headaches in children can present in an apoplectic manner that garners immediate medical attention, or in an insidious, more dangerous form that may go unnoticed for a relatively long period of time. The recognition of certain clinical characteristics that accompany the headache should prompt recognition and referral to an institution equipped with neuroimaging facilities, pediatric neurosurgeons, and neurologists. Thunderclap headaches, which reach a peak within a very short period of time, may be the presenting feature of conditions such as arterial dissection, venous sinus thrombosis, and reversible cerebral vasoconstriction syndrome, which can be addressed by specific pharmacological options instituted in an intensive care setting.