Fifteen-year-old girl with systemic lupus erythematosus and unilateral cerebellitis.

Cerebellar involvement in systemic lupus erythematosus has rarely been described as one of the neurologic manifestations. There has been only one previous pediatric case of cerebellar edema reported in the literature. The differential diagnosis, magnetic resonance imaging findings and treatment modalities are described in the case of a 15-year-old girl who presented with headache, vomiting, unsteady gait, and sudden change in mental status.

The use of antiepileptic drugs in pediatric brain tumor patients.

Antiepileptic drugs are frequently used in children with brain tumors. This retrospective study reviewed chronic use of antiepileptic drugs in children with brain tumors at two children's hospitals between 2000 and 2007. Antiepileptic drugs were used in 32/334 pediatric brain tumor patients (10%).

Familial hemiplegic migraine with prolonged aura and multimodality imaging: a case report.

We report a case of familial hemiplegic migraine with prolonged aura where multimodality imaging showed hemispheric cytotoxic edema along with evidence of hypometabolism in the affected hemisphere while there was no evidence of hypoperfusion of the affected hemisphere demonstrating that neuronal depression is a more plausible explanation in its pathogenesis.

Efficacy of levetiracetam in children with epilepsy younger than 2 years of age.

Despite the high incidence of epilepsy in very young children, the availability of approved antiepileptic drugs for this population is limited. This study assessed the efficacy and tolerability of levetiracetam in children younger than 2 years of age with various types of epilepsy. A single-center, retrospective chart review of 28 patients ranging in age from 2 weeks to 22 months treated with levetiracetam over a 2.

Emergency department admission of children with unprovoked seizure: recurrence within 24 hours.

Little is known about acute recurrence of seizures, and children with unprovoked seizure tend to be admitted for observation on the basis of the risk factors known for epilepsy. The purpose of this study is to define the clinical profile of pediatric seizure patients who are likely to be admitted and to analyze the incidence and the risk factors of acute recurrence of seizures in the admitted patients within 24 hours after admission. A retrospective chart review was performed on pediatric patients who arrived to the Schneider Children's Hospital Emergency Department because of an unprovoked seizure who were not on antiepileptic medication.

Attention-deficit/hyperactivity disorder: a preliminary diffusion tensor imaging study.

Background: The purpose of this study was to explore whether there are white matter (WM) abnormalities in children with attention-deficit/hyperactivity disorder (ADHD) using diffusion tensor imaging. Based upon the literature, we predicted decreased fractional anisotropy (FA) findings in the frontal and cerebellar regions.

Methods: Eighteen patients with ADHD and 15 age- and gender-matched healthy volunteers received DTI assessments.

External hydrocephalus: a probable cause for subdural hematoma in infancy.

Subdural hemorrhage is common in infancy, particularly in the first year of life. The most common cause is nonaccidental (child abuse), with accidental in second place. We present three healthy infants, ages 4, 5, and 7 months that, during an evaluation for macrocephaly, were found to have frontal subdural hematoma in association with prominent extracerebral cerebrospinal fluid spaces (external hydrocephalus).

Spontaneous spinal epidural hematoma: an uncommon presentation of a rare disease.

Introduction: Spontaneous spinal epidural hematoma is rare in children. The presenting symptoms are usually pain, either local or radicular, followed by progressive bilateral weakness, and sensory loss hours and even days later. In the absence of significant precipitating factors such as severe trauma or previously known coagulopathies the diagnosis is usually delayed, and it is not until the full picture of severe cord compression is developed, that MRI is done and the diagnosis is finally made.

Short-term outcomes of children with febrile status epilepticus.

Febrile status epilepticus (SE) represents the extreme end of the complex febrile seizure spectrum. If there are significant sequelae to febrile seizures, they should be more common in this group. We have prospectively identified 180 children aged 1 month to 10 years who presented with febrile SE over a 10-year period in Bronx, New York, and Richmond, Virginia.

Biphasic course of infant botulism.

The syndrome of infant botulism, characterized by constipation, poor feeding, hypotonia, poor head control, and bulbar involvement, is typically a monophasic disease. We describe a 7-month-old infant with a recurrence of illness 13 days after resolution of the presenting signs. The source of infection was unknown and the only potential risk factors were exclusive breastfeeding and decreased bowel movements, which by themselves cannot explain the recurrence.

The role of brain computed tomography in evaluating children with new onset of seizures in the emergency department.

Background: The purpose of neuroimaging of a patient with new onset of seizures is to demonstrate cause and explore the prognosis. It was recently recommended that emergency brain computed tomography (CT) be performed only in adult seizure patients with an increased likelihood of life-threatening lesions, i.e.

Headaches in a pediatric emergency department: etiology, imaging, and treatment.

Objective: To assess the spectrum of diagnoses, the use of CT scans of the brain, and pharmacological treatments in patients presenting to a pediatric emergency department with headaches as the chief complaint.

Methods: A 1-year retrospective chart review of all children who presented to the emergency department with a headache as the chief complaint.

Results: One hundred thirty patients (0.

The value of early postictal EEG in children with complex febrile seizures.

Purpose: To assess the usefulness of an early postictal EEG in neurologically normal children with complex febrile seizures.

Methods: We conducted a retrospective chart review of all neurologically normal children who were hospitalized over a period of 2.5 years after complex febrile seizures, and had an EEG up to 1 week after the seizure.

Midazolam coma for refractory status epilepticus in children.

Objective: To implement and retrospectively evaluate a therapeutic algorithm for the treatment of refractory status epilepticus with midazolam coma.

Methods: Eight consecutive patients with refractory status epilepticus were mechanically ventilated. Their arterial and central venous blood pressures were continuously monitored by indwelling vascular catheters.

Risk of excessive weight gain in epileptic children treated with valproate.

We sought to identify factors associated with excessive weight gain in children treated with valproate, excluding patients fed by gastrostomy or treated with medications known to affect appetite (eg, stimulants). Weight and height were recorded before treatment and at the time of follow-up; a measure of adiposity, body mass index, was computed and expressed in kg/m2, and weight and height for age were converted to Z-score. Putative risk factors included sex, age at start of treatment, monotherapy at start of treatment, duration of follow-up, mental retardation, seizure type (generalized or partial), etiology (idiopathic or cryptogenic versus remote symptomatic), and dose of valproate.

Basilar artery migraine and reversible imaging abnormalities.

We report a case of a basilar artery migraine in a 17-year-old boy with transient CT and MR abnormalities after each of two migraine episodes. A repeat MR study 6 months after the last event showed complete resolution of the lesion. Transient abnormalities on brain images similar to those shown in our case have been reported in patients with migraine and other neurologic conditions and are most likely related to cerebral vasogenic edema.

Pseudotumor cerebri in Lyme disease: a case report and literature review.

Pseudotumor cerebri is an unusual presentation of Lyme disease. The case of an 8-year-old girl with pseudotumor cerebri secondary to acute neuroborreliosis is reported. She presented with acute onset of headache, papilledema, sixth nerve palsy, increased intracranial pressure, and cerebrospinal fluid pleocytosis.

The value of head ultrasound in infants with macrocephaly.

Objective: To assess the value of head ultrasound (HUS) in neurologically normal infants with macrocephaly and to develop a rational approach to radiological investigation of macrocephalic infants.

Materials And Methods: A retrospective analysis of infants with macrocephaly (seen by one pediatric neurologist at this institution) was conducted. Infants with normal neurological examinations, no evidence of raised intracranial pressure and who had undergone a HUS were included.

The incidence of acute and remote seizures in children with intraventricular hemorrhage.

Seizures are a well-known complication of intraventricular hemorrhage (IVH) in premature infants; however, the rate at which they occur is not known. The authors decided, therefore, to investigate both the incidence of acute and remote seizures in infants with IVH and the association with the grade of hemorrhage. One hundred and three infants with IVH were identified and their records were reviewed for acute seizures, remote seizures, and associated morbidity and mortality.

In whom does status epilepticus occur: age-related differences in children.

Purpose: Status epilepticus (SE) is an uncommon but potentially life-threatening seizure. It is most common in children. Little is known about the differences within the pediatric age group in terms of the type of patient seen with SE.

Risk factors for status epilepticus in children with symptomatic epilepsy.

The purpose of this study was to determine risk factors for status epilepticus (SE) in children with symptomatic epilepsy through a retrospective case-control study. Patients (44 children with a prior diagnosis of symptomatic epilepsy experiencing one or more episodes of SE between January 1, 1991, and June 1, 1995) were matched for age at follow-up to controls (88 children with symptomatic epilepsy without SE during that interval) and medical records were reviewed. Patients and controls did not differ in etiology or in age at epilepsy onset (1 year 5 months [SD, 2 years 3 months] versus 1 year 3 months [SD, 1 year 5 months]).

Pediatric migraine and the International Headache Society (IHS) criteria.

Background: The optimal criteria for the diagnosis of migraine without aura in children are controversial. One strategy for assessing the validity of diagnostic criteria is to compare them with expert clinical diagnoses.

Objective: To study the agreement between clinical headache diagnoses assigned by pediatric neurologists and symptom-based diagnoses using the International Headache Society (IHS) criteria as well as alternative case definitions.

Status epilepticus in children with epilepsy: the role of antiepileptic drug levels in prevention.

Objectives: To determine the association between subtherapeutic antiepileptic drug (AED) levels or AED withdrawal and status epilepticus (SE) in children with epilepsy.

Methods: We studied the AED levels at the time of SE in 51 consecutive children with epilepsy. Information about prior AED levels, possible etiology of seizures, and acute precipitants was extracted from medical records.

Subdural empyema in 12-year-old girl: the value of magnetic resonance imaging.

A 12-year-old girl presented with an acute history of fever, headaches, and focal neurological deficits. An initial computed tomography (CT) scan of the head was nondiagnostic whereas plain and gadolinium-enhanced magnetic resonance imaging (MRI) detected an extensive subdural empyema. The report emphasizes the hazard of relying on a nondiagnostic CT scan in a septic patient with deteriorating neurological function, and the need of MRI with contrast enhancement if subdural empyema is a serious clinical concern.