RESUMEN
INTRODUCTION: Paediatric pseudotumour cerebri or idiopathic intracranial hypertension syndrome is rare in the paediatric age and presents with clinical features that differ from the clinical picture seen in adults. It is not a benign condition in children and, although sometimes used to identify this syndrome, the term 'benign intracranial hypertension' must therefore be avoided. It is characterised by an increase in the intracranial pressure with analytically normal cerebrospinal fluid and the absence of expansive injuries detected by means of neuroimaging. DEVELOPMENT: It is a complex syndrome that causes intense headaches in children with acute loss of vision and, on occasions, optic atrophy. Its treatment has to be tailored to each patient and the use of different pharmacological or neurosurgical treatments must be considered to avoid permanent visual damage. We reviewed the case mix at our Institute over the last 10 years (1995-2005) and found 23 children (between 3 and 15 years of age) who fulfilled Dandy criteria confirming a diagnosis as suffering from paediatric pseudotumour cerebri, with no predominance of sex or associated obesity. CONCLUSIONS: Its treatment must be established on an individualised basis, as well as ongoing and multidisciplinary; fenestration of the optic nerve sheath or the implantation of lumboperitoneal shunts correct refractory syndromes, which in our case accounted for 35% of the total number. The rest were treated with acetazolamide, diet and steroids.
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Seudotumor Cerebral , Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Seudotumor Cerebral/diagnóstico , Seudotumor Cerebral/epidemiología , Seudotumor Cerebral/etiología , Seudotumor Cerebral/terapia , Estudios RetrospectivosRESUMEN
INTRODUCTION: The purpose of the present review was to analyse the comorbidity that exists between attention deficit hyperactivity disorder (ADHD) and sleep disorders in children and adolescents, together with their clinical characteristics, diagnosis and treatment regimens. DEVELOPMENT: ADHD and sleep disorders are a frequent cause of visits in neuropaediatric departments. Around 25% of children with ADHD have some kind of sleep disorder but, unlike the case of adults, these often remain undetected. We nearly always choose to improve hyperactivity, attention deficit and impulsiveness symptomatically and forget to treat the associated sleep disorder. CONCLUSIONS: There is a clear correlation between ADHD and sleep disorders and they are very common in visits to the neuropaediatric department. Diagnosis of these patients is clinical. Neurophysiological evaluation, especially using polysomnography, provides objective confirmation of the symptoms. Novel treatments such as melatonin and other drugs are now available to improve the sleep pattern. By improving these children's sleep, the symptoms of ADHD are diminished and thus avoid the need to administer psychostimulants, which have undesirable side effects that produce a great deal of anxiety in the parents of these children.
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Trastorno por Déficit de Atención con Hiperactividad/complicaciones , Trastornos del Sueño-Vigilia/etiología , Adolescente , Niño , Humanos , Trastornos del Sueño-Vigilia/diagnóstico , Trastornos del Sueño-Vigilia/terapiaRESUMEN
INTRODUCTION: The acronym PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus) describes the neuropsychiatric disorders resulting from an autoimmune response to an infection by streptococcus in children. AIMS: The aim of this study was to clinically analyse 38 patients under the age of 16 with tics, Tourette syndrome (TS) or obsessive compulsive disorder (OCD) and their possible association to an infection caused by group A beta-haemolytic streptococcus (GABHS). METHOD: We reviewed the medical records at the Instituto Neurológico in Valencia (Venezuela) over a 12 year period (1988-2000). All the patients met the inclusion criteria set out by the National Institute of Mental Health in Bethesda (1997) and the DSM-IV. RESULTS: Onset of the symptoms was higher in the group of schoolchildren (n=24), followed by the group of preschool children (n=8) and adolescents (n=6). Males were predominant (n=33) (86.8%). 17 patients presented chronic tics (44.7%), 13 had transitory tics (34.2%) and there were eight cases of TS (21.1%). The most frequently related comorbid disorders were: difficulties in learning (n=30) (78.9%), ADHD (n=27) (71.1%), OCD 14 (36.8%), sleep disorders (n=14) (36.8%), behavioural disorders (n=12) (31.6%), language disorders (n=11) (28.9%), psychomotor disorders (n=10) (26.3%) and nocturnal enuresis (n=7) (18.4%). Electroencephalogram patterns were abnormal in 72.4% (n=12), and the disorganised pattern was the most frequently observed (n=12) (41.4%), followed by a slow diffuse pattern (n= 7) (24.1%) and the left centro-parieto-temporal focal paroxysmal specific pattern (n=7) (24.1%). Less frequently we found unspecific generalised paroxysmal patterns, in four cases (13.8%), and asymmetrical patterns (n=1) (3.4%). The association with an infection by streptococcus was shown in two cases, which amounted to 5.2% of the sample. CONCLUSIONS: The obtained are similar to those reported in the literature. Only 5.2% of the cases were linked to a prior streptococcus infection.
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Enfermedades Autoinmunes/etiología , Trastornos Mentales/etiología , Enfermedades del Sistema Nervioso/etiología , Infecciones Estreptocócicas/complicaciones , Adolescente , Enfermedades Autoinmunes/diagnóstico , Enfermedades Autoinmunes/terapia , Niño , Preescolar , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia , Enfermedades del Sistema Nervioso/diagnóstico , Enfermedades del Sistema Nervioso/terapia , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/terapiaRESUMEN
INTRODUCTION: In order to reduce intracerebral trauma in the diagnosis and treatment of intracranial lesions in children, neuroendoscopy is an important tool in current neurosurgery. Using this minimally invasive technique intraventricular objectives may be approached with little damage caused to adjacent structures. OBJECTIVES: There are two aspects to current indications for neuroendoscopy. Firstly, diagnosis is achieved by taking intraventricular biopsies of cystic lesions and tumours and for anatominical vigilance in microsurgical operations. Secondly, there is the therapeutic aspect, especially in operations to restore the circulation of cerebrospinal fluid (CSF), correct complex hydrocephaly, insert or remove intraventricular shunts, aspiration of cysts or haematomas, fenestration of cysts, resection of tumours within or near the ventricles. DEVELOPMENT: At the present time in neurosurgical paediatric management, neuroendoscopy is a tool used daily in common lesions such as hydrocephaly and the identification of intraventricular lesions. It may be safely used as a primary method of approach to the lesions or as a complement to open or guided surgery to the patient s advantage. We therefore reviewed the literature in the light of our own experience in neuroendoscopy since 1996. CONCLUSIONS: The formal indications for neuroendoscopy are greater in paediatric neurosurgery. In fact, the management of the CSF circulation, and disorders associated with this, together with the identification of tumours using minimally invasive methods, make this technique directly useful for solving these problems. This is most obvious in lesions such as multiseptate complex hydrocephaly, and intraventricular tumours and cysts where it is the first surgical option. In the short term, thanks to improvements in neuro navigation and frameless stereotaxis, its use will be wider and more precise
Asunto(s)
Ventrículos Cerebrales/cirugía , Neuroendoscopía/estadística & datos numéricos , Pediatría/métodos , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/cirugía , Ventrículos Cerebrales/patología , Niño , Diagnóstico Diferencial , Hematoma Subdural/cirugía , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/patología , Hidrocefalia/cirugía , Imagen por Resonancia Magnética , Procedimientos Quirúrgicos Mínimamente Invasivos , Neuroendoscopía/métodos , Técnicas Estereotáxicas , Terapia Asistida por ComputadorRESUMEN
Minimally invasive neurosurgical techniques permit improved ways of approaching problems which could previously only be solved by open surgery or microsurgery. In this field, neuroendoscopy offers a very efficient, clear means of diagnosis and a less aggressive form of treatment of lesions on the central nervous system. Particularly in paediatric neurosurgery, procedures such as implanting valves for ventriculo-peritonial derivations (DVP) may be carried out knowing the exacts anatomical site of the catheter tip, or allowing catheters adherent to structures such as the choroid to be removed. Ventriculoscopy permits review and biopsy of intraventricular and paraventricular structures. Myeloscopy allows intramedullary and paramedullary visualization together with the possibility of syringoscopy. The new option presented by neuroendoscopy, as a help in microneurosurgery, when studying structures which are not visible using a microscope, is particularly useful in vascular surgery and in surgery of the base of the skull. It also permits rapid, efficient drainage of subdural and intraventricular haematomas. This technique has become a useful tool in neurosurgical departments for solving problems and as a support for the classical techniques. Equally it requires practice and the study of neuroendoscopic anatomy.