RESUMEN
Early markers of neurological outcome in the absence of overt brain damage are scarce in extreme prematurity. The aim of this study was to compare spectral EEG values of infants born near term with those of infants born at extremely low gestational age (ELGA) but having attained near term age. We aimed also to evaluate whether spectral EEG features were related with neurological outcome. The ELGA group consisted of 12 neonates born between 23+2 and 27+6 weeks; the control group consisted of nine infants born 34-35+2 weeks, tested within the first week of life. All neonates underwent multichannel EEG recordings at 35 weeks post-conception. None of the subjects had apparent neurological abnormalities or risk factors at the time of recording. EEG data were transformed into the frequency domain and divided into delta (0.5-4Hz), theta (5-7Hz), alpha (8-13Hz), beta (14-20Hz) frequency bands; relative EEG power values were calculated. ELGA group was compared with the control group using a mixed analysis of variance. Outcome was evaluated at one year of age by Griffiths' scales. A principal effect of frequency and an interaction effect of frequency * group was found. The total relative power of the delta band was significantly higher in ELGA than in control group, whereas in the remaining frequency bands total relative power was lower in ELGA than in control group. Higher values of delta and lower values of alpha and beta spectral power correlated with poor outcome. We provide preliminary results suggesting that, as early as 35 weeks post conception, infants born extremely preterm fail to develop the age specific pattern of EEG spectral activity, in the absence of neurological neonatal risk.
Asunto(s)
Ondas Encefálicas , Encéfalo/crecimiento & desarrollo , Recien Nacido Extremadamente Prematuro/crecimiento & desarrollo , Electroencefalografía , Femenino , Edad Gestacional , Humanos , Recién Nacido , Masculino , Procesamiento de Señales Asistido por ComputadorRESUMEN
Chiari malformation type 2 is characterized by hindbrain protrusion and a constellation of supratentorial malformations. Chiari malformation type 2 is thought to be causally related to myelomeningocele due to intrauterine cerebrospinal fluid overdrainage. This relationship is so strong that it has become a rule. A 14-year-old girl affected by mental retardation, spastic triparesis, and epilepsy is presented. Brain magnetic resonance imaging disclosed a severe Chiari malformation type 2, whereas spine magnetic resonance imaging was unremarkable. The authors discuss previous literature describing rare cases of Chiari malformation type 2 without open spinal dysraphism and the relevance of concomitant, sometimes overlooked, neuroimaging findings, underlying how exceptions might be hurdles but might also eventually strengthen the rules.
Asunto(s)
Agenesia del Cuerpo Calloso/complicaciones , Malformación de Arnold-Chiari/complicaciones , Malformación de Arnold-Chiari/diagnóstico , Malformaciones del Desarrollo Cortical/complicaciones , Adolescente , Agenesia del Cuerpo Calloso/patología , Femenino , Humanos , Imagen por Resonancia Magnética , Malformaciones del Desarrollo Cortical/patologíaRESUMEN
BACKGROUND: Congenital cytomegalovirus (CMV) infection can lead to severe neurological sequelae, but a defined brain magnetic resonance (MR) pattern and MR predictors of clinical outcome are still lacking. MATERIALS AND METHODS: Clinical and MR findings of 14 children with symptomatic congenital CMV infection were retrospectively reviewed. RESULTS: Microcephaly, cerebral palsy and epilepsy were found in eight, six and seven patients, respectively (all concomitant in 6); 12 children developed sensory-neural hearing loss (SNHL). At first MRI (mean age 21 months, range 5-54 months), white matter (WM) involvement was not assessable in two children due to incomplete myelination. WM abnormalities were common (11/12 patients); deep WM was predominantly involved in 5/11; the largest WM lesion was in the parietal lobe in 6/11. Anterior temporal lobe abnormalities were found in 13/14. Six children underwent MRI examination after 2 years of life; in this subgroup, WM abnormalities were extensive and confluent (4/6), bilateral and multifocal (1/6) or absent (1/6). Four children showed a progression of myelination. Ventriculomegaly (9/14), migration disorders (6/14 polymicrogyria and 1/14 pachygyria-lissencephaly) and hippocampal dysplasia (6/14) correlated with severe neurological sequelae (p < 0.05, Fisher exact test), while the presence of WM abnormalities (11/12), periventricular cysts (6/14) and cerebellar hypoplasia (4/14) did not predict the outcome. CONCLUSIONS: The spectrum of brain MR abnormalities in symptomatic congenital CMV infection is extremely wide. WM involvement is variable, difficult to evaluate at a very young age and unrelated to clinical outcome, while cortical malformations, ventriculomegaly and hippocampal dysplasia seem to be strong predictors of poor outcome except for SNHL.