The diagnosis and management of delirium in infancy.

Objective: Atypical antipsychotics have been documented to be effective in the management of delirium in adults and older children, but despite considerable need, their use has been less studied in the very young. A retrospective chart review was undertaken to describe the use of atypical antipsychotics in controlling symptoms of delirium in infants and toddlers.

Methods: All psychiatric inpatient consultations performed during a 3 year period were reviewed to identify children <36 months old diagnosed with delirium.

Symptoms before and after posterior fossa surgery in pediatric patients.

Unlabelled: The posterior fossa syndrome (PFS) is common after cerebellar tumor resection in pediatric patients. It is characterized by postoperative mutism and ataxia and associated with persistent abnormalities in mood and cognition.

Method: A 2-year prospective study of children and adolescents with cerebellar tumors identified by neuroimaging was performed at the Children's Hospital Los Angeles.

Atypical antipsychotic medications to control symptoms of delirium in children and adolescents.

Background: Atypical antipsychotics have been documented to be effective in the management of delirium in adults, but despite considerable need, their use has been less studied in pediatric patients.

Objective: A retrospective chart review was done to describe the use of atypical antipsychotics in controlling symptoms of delirium in children and adolescents.

Methods: Pharmacy records at Children's Hospital Los Angeles were reviewed to identify patients to whom antipsychotic agents were dispensed over a 24-month period.

Hydrographic magnetic resonance imaging of the fetal eye.

Previous work has shown that fetal hydrographic magnetic resonance imaging (MRI) provided additional information complementary to T2-weighted single-shot fast spin echo (ssFSE) images. The objective of this study was to determine if hydrographic MRI provides better conspicuity of fetal eye structures compared with ssFSE MRI. ssFSE and hydrographic images were retrospectively examined in 82 consecutive fetal studies with normal central nervous system without sensitivity encoding.

Abnormal microstructure of the atrophic thalamus in preterm survivors with periventricular leukomalacia.

Background And Purpose: The neuroanatomic substrate of cognitive deficits in long-term survivors of prematurity with PVL is poorly understood. The thalamus is critically involved in cognition via extensive interconnections with the cerebral cortex. We hypothesized that the thalamus is atrophic (reduced in volume) in childhood survivors of prematurity with neuroimaging evidence of PVL and that the atrophy is associated with selective microstructural abnormalities within its subdivisions.

In utero eye development documented by fetal MR imaging.

Background And Purpose: To date, very limited attention has been given to ocular abnormalities or growth parameters detected by fetal MR imaging. Our objective was to retrospectively determine the relationship between different parameters of eye development and estimated gestational age in the human fetus by use of fetal MR imaging.

Materials And Methods: A retrospective study was performed to measure the transverse diameter, interocular distance, and lens diameter of the globes of 127 fetuses who had a morphologically normal central nervous system.

Histologic features and prognosis in pediatric medulloblastoma.

Because individual histologic features in childhood medulloblastoma alter survival likelihood, the recent 4th edition of the World Health Organization (WHO) Classification of Brain Tumors recognizes desmoplastic/nodular medulloblastoma, medulloblastoma with extensive nodularity, large cell medulloblastoma, and anaplastic medulloblastoma, in addition to medulloblastoma with no other distinguishing features. To identify features affecting survival likelihood, we investigated 33 histologic features in 556 childhood tumors diagnosed as medulloblastoma in the Childhood Brain Tumor Consortium (CBTC) database; all features have CBTC verified read-reread reliability and those features important in the classification of medulloblastoma and its WHO variants regardless of their measured reliability. Nineteen features had no effect on survival likelihood, and 8 features were too prevalent or too rare to measure their effect on survival.

Pathologist interobserver variability of histologic features in childhood brain tumors: results from the CCG-945 study.

In the Children's Cancer Group-945 trial, study design allowed estimation of overall interpathologist observational agreement for 6 histologic features frequently used in brain tumor diagnoses. We evaluated agreement between pairs of 5 experienced neuropathologists, who had knowledge of the general diagnoses prior to slide readings. We performed this study in an attempt to further improve pathologist interinstitutional agreement.

Late onset psychosis in survivors of pediatric central nervous system malignancies.

Survivors of pediatric intracranial malignancies are at recognized high risk for neurocognitive and psychosocial dysfunction, endocrinopathies, growth abnormalities, and second neoplasms. The late onset of persistent psychosis may represent an additional serious psychiatric consequence of childhood intracranial malignancies. The authors report eight survivors of pediatric intracranial malignancies whose course was complicated by the delayed onset of hallucinations, delusions, and bizarre behavior 2 to 12 years after diagnosis and treatment of brain tumors.

Comparing symptoms of delirium in adults and children.

Delirium is presumed to be the same syndrome in all ages. Comparing pediatric and adult studies, the authors found many of the same symptoms reported, but often at significantly different rates. Sleep-wake disturbance, fluctuating symptoms, impaired attention, irritability, agitation, affective lability, and confusion were more often noted in children; impaired memory, depressed mood, speech disturbance, delusions, and paranoia, more often in adults; impaired alertness, apathy, anxiety, disorientation, and hallucination occurrence were similar.

Mood and behavioral dysfunction with opsoclonus-myoclonus ataxia.

Opsoclonus-myoclonus ataxia syndrome is a paraneoplastic syndrome of cerebellar damage associated with neuroblastoma. The authors assessed psychiatric symptoms of opsoclonus-myoclonus ataxia syndrome in 17 children, who were 16 months to 12(1/2) years of age. Psychiatric symptoms examined included disruptive behavior, affective dysregulation, irritability, impulsivity, cognitive impairment, and poor attention.

Disordered respiratory control in children with partial cerebellar resections.

While the cerebellum is not traditionally thought of as having an important role in respiratory control, breathing involves cyclic motor acts that require cerebellar coordination. We postulate that children with partial cerebellar resections have disordered respiratory control due to altered synchronization of ventilatory muscles. We reviewed the records of 36 children following partial cerebellar resections due to neoplasms confined to the cerebellum.

Case series: acute mood symptoms associated with posterior fossa lesions in children.

Nineteen children were acutely dysphoric, inattentive, irritable, and sometimes mute following midline posterior fossa neoplasm resection and arteriovenous malformation hemorrhage. These symptoms represent an acute manifestation of the cerebellar cognitive affective syndrome. The authors aimed to describe the acute psychiatric changes in mood and behavior in children with posterior fossa lesions and to evaluate the relationship of posterior fossa syndrome to cerebellar cognitive affective syndrome.

Prognostic limitations of the Daumas-Duport grading scheme in infratentorial neuroglial tumors in children.

The Daumas-Duport grading scheme (DDGS) utilizes four histologic features in an additive method (grade 1 if none present, grade 2 if only one is present, etc.). Its efficacy in achieving prognostically homogeneous groups of childhood infratentorial neuroglial tumors and its concordance with World Health Organization (WHO) diagnoses has not been evaluated.

Delirium in children and adolescents.

Rarely reported in pediatric patients, the characteristic symptoms and course of delirium are well known in adults. This retrospective study was undertaken to describe the clinical presentation, symptoms, and outcome of delirium in children and adolescents. Eighty-four patients age 6 months to 18 years were identified with delirium, from 1,027 consecutive psychiatric consultations during a 4-year period.

Changes in the size of the lateral ventricles in the normal-term newborn following vaginal delivery.

Background: This is a study of the size of the lateral ventricles in a population of normal-term newborns following vaginal delivery.

Objective: To assess the time course for the lateral ventricles to change from closed to open following vaginal delivery.

Materials And Methods: A total of 143 normal-term newborns had a videotaped cranial ultrasound examination during the period from 1 to 156 h after birth.

The delirium rating scale in children and adolescents.

The study of delirium has been neglected in pediatric patients, and there are no diagnostic criteria or rating scales adapted for use in this age group. The Delirium Rating Scale is widely used to diagnose and rate the severity of delirium in adults. It was retrospectively administered to 84 children and adolescents diagnosed with delirium to evaluate its applicability in pediatric patients.

Clinical and survival covariates of eight classes of childhood supratentorial neuroglial tumors.

Background: In the current study, the authors investigated clinical, surgical, and histologic characteristics (covariates) and their interactions in eight previously identified classes of childhood supratentorial neuroglial tumors. The classes resulted from 5 factor score profiles on 703 supratentorial neuroglial tumors in the Childhood Brain Tumor Consortium database.

Methods: The Cox proportional models were used to identify class survival covariates.

Bone, muscle, and fat: sex-related differences in prepubertal children.

Purpose: To determine whether there are sex-related differences in vertebral cross-sectional dimensions, in paraspinous muscle area, and in the amount of fat in the subcutaneous and visceral compartments of prepubertal boys and girls.

Materials And Methods: Subcutaneous fat, visceral fat, paraspinous musculature, and vertebral cross-sectional dimensions were studied in 31 pairs of prepubertal healthy white girls and boys 5-10 years of age, rigorously matched for age, height, and weight. Data were analyzed with the Student t test and multiple regression analysis.

Globus pallidus glial pigment and its changes with age and chronic illness in childhood.

Glial lipopigment appears in the globus pallidus without accumulating in neurons (except for late adolescence) in multiple chronic childhood diseases. In this observational study, we compared the age-related development of glial pigmentation in children with the chronic illness (cystic fibrosis) and children dying acutely. A secondary goal was to search for pallidal neuronal lipopigment in childhood.

Limitations of the World Health Organization classification of childhood supratentorial astrocytic tumors. Children Brain Tumor Consortium.

Background: In the context of many implied but not rigorously stated histologic feature combinations, the World Health Organization (WHO) classification of astrocytic tumors specifies only the presence or absence of endothelial proliferation, necrosis, and mitosis to distinguish astrocytoma, anaplastic astrocytoma, and glioblastoma multiforme.

Methods: The authors examined the effects of these and other reliably recognized histologic features on survival in the Childhood Brain Tumor Consortium (CBTC) sample of 340 children with supratentorial astrocytic tumors.

Results: Overall, the WHO criteria distinguished only two prognostically distinct classes of astrocytomas.

Definitive classes of childhood supratentorial neuroglial tumors. The Childhood Brain Tumor Consortium.

Our objective in this study was to identify histologically homogenous classes of childhood supratentorial neuroglial tumors. Previously, we identified five quantitative histologic factors (differing linear combinations of 17 reliably recognized histologic features in neuroglial tumors). They account for much of the histologic variance in the 703 supratentorial tumors in the Childhood Brain Tumor Consortium (CBTC) database.

Prognostic limitations of the Daumas-Duport grading scheme in childhood supratentorial astroglial tumors.

The Daumas-Duport grading scheme (DDGS) is a commonly used method for determining the grade of a tumor. It scores 4 histologic features and is used as a prognostic tool in adult astroglial tumors. This system of assigning children to prognostically homogeneous groups has not been evaluated.

Clusters of histologic characteristics in children with infratentorial neuroglial tumors. The Childhood Brain Tumor Consortium.

Five quantitative histologic factors, differing linear combinations of 26 reliably recognized histologic features, account for much of the histologic variance in 1068 children with infratentorial neuroglial tumors in the Childhood Brain Tumor Consortium (CBTC) database. In this study, we used the scores on the Spongy, Proliferative, Ring, Fibrillary, and Nuclear factors in cluster analyses and identified 11 clusters of children's tumors. Each had statistically significant differences in histology and relative histologic homogeneity.

Quantitative histologic factors for grouping childhood infratentorial neuroglial tumors.

We employed factors analysis to quantify the degree of histologic heterogeneity of childhood infratentorial neuroglial tumors. Our data were 26 reliably ascertained histologic features in 1068 children in the Childhood Brain Tumor Consortium database. The factor analysis identified five uncorrelated quantitative "factors," each derived from a different linear combination of the 26 histologic features, that accounted for much of the histologic variation.