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Introducción: En los últimos años ha aumentado el interés por el ictus en la infancia. La revisión de la literatura aporta poca información sobre factores de riesgo y otros aspectos de interés clínico. El objetivo es describir las características del ictus en niños con el objetivo de identificar factores de riesgo, presentación clínica y el pronóstico. Pacientes y métodos: Se llevó a cabo un estudio retrospectivo entre los pacientes ingresados en el hospital La Fe entre enero de 2000 y septiembre de 2010 con los diagnósticos de ictus, isquémicos o hemorrágicos. Resultados: Un total de 76 pacientes cumplían los criterios de inclusión, 44,7% presentaron un ictus isquémico y 55,3% fue hemorrágico. La edad media de presentación fue de 6,8 años, 8,4 años para los hemorrágicos y 4,7 años para los isquémicos. La cefalea fue el síntoma de presentación más frecuente. El principal factor de riesgo fue la malformación vascular en los ictus hemorrágicos y las vasculopatías y cardiopatías en los isquémicos. En 34 pacientes se llevó a cabo un estudio de trombofilia y en un 64,7%, de estos, el estudio fue positivo. Respecto al pronóstico, el 17% de los pacientes falleció, solamente tres pacientes presentaron una epilepsia secundaria y el 31 y 60% de los infartos hemorrágicos e isquémicos, respectivamente, desarrollaron una hemiparesia. Conclusiones: En este estudio hemos identificado los principales factores de riesgo, así como edad de presentación, sintomatología y pronóstico. Queremos destacar la edad de presentación más precoz en los ictus isquémicos frente a los hemorrágicos(AU)

Introduction: There has been increasing interest in stroke in children in the last few years. A literature review produced little information on risk factors and other clinical questions. The aim of this study is to describe the characteristics of stroke in children, mainly in order to identify the risk factors, clinical presentation and outcomes. Patients and methods: A retrospective study was conducted on patients admitted to the Hospital La Fe in Valencia between January 2000 to September 2010 with the diagnosis of ischaemic or haemorrhagic stroke. Results: A total of 76 patients were identified, of whom 44.7% had an ischaemic stroke and 55.3% had a haemorrhagic one. The average age of presentation was 6.8 years; 8.4 years for haemorrhagic strokes and 4.7 years for ischaemic strokes. Headache was the most frequent symptom of presentation. The most frequent risk factor was vascular malformations in haemorrhagic cerebral stroke, and vascular and cardiac disorders in ischaemic stroke. A study of prothrombotic factors was conducted on 34 patients, which was positive in 64.7% of them. As regards outcome, 17% of the patients died; only 3 patients had a secondary epilepsy, and 31% and 60% of the haemorrhagic and ischaemic stokes, respectively, had a hemiparesis. Conclusions: In this study we identified the principal risk factors as well as, the age of presentation, symptomatology and outcome. We would like to emphasise that the age of presentation was earlier in ischaemic strokes than in haemorrhagic ones(AU)

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INTRODUCTION: There has been increasing interest in stroke in children in the last few years. A literature review produced little information on risk factors and other clinical questions. The aim of this study is to describe the characteristics of stroke in children, mainly in order to identify the risk factors, clinical presentation and outcomes. PATIENTS AND METHODS: A retrospective study was conducted on patients admitted to the Hospital La Fe in Valencia between January 2000 to September 2010 with the diagnosis of ischaemic or haemorrhagic stroke. RESULTS: A total of 76 patients were identified, of whom 44.7% had an ischaemic stroke and 55.3% had a haemorrhagic one. The average age of presentation was 6.8 years; 8.4 years for haemorrhagic strokes and 4.7 years for ischaemic strokes. Headache was the most frequent symptom of presentation. The most frequent risk factor was vascular malformations in haemorrhagic cerebral stroke, and vascular and cardiac disorders in ischaemic stroke. A study of prothrombotic factors was conducted on 34 patients, which was positive in 64.7% of them. As regards outcome, 17% of the patients died; only 3 patients had a secondary epilepsy, and 31% and 60% of the haemorrhagic and ischaemic stokes, respectively, had a hemiparesis. CONCLUSIONS: In this study we identified the principal risk factors as well as, the age of presentation, symptomatology and outcome. We would like to emphasise that the age of presentation was earlier in ischaemic strokes than in haemorrhagic ones.

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INTRODUCTION AND DEVELOPMENT: Attention deficit hyperactivity disorder (ADHD) is one of the most frequently observed processes in our Neuropaediatric unit, and in recent years has become one of the leading reason for visits, together with headaches. On occasions, the diagnosis that should be made, in accordance with the criteria included in the DSM IV, is more difficult because initially they are patients who visit because of some other problem that becomes the centre of our clinical attention. Headaches, in our experience, are the main reason for visiting in these cases. A careful review of the patient's history and a physical examination, together with their observation during the interview, lead us to suspect a genuine case of ADHD underlying the problem that presents with other non specific symptoms. These patients are mainly boys and, less frequently, girls who see how the chances of academic and social failure increase and then become worried to such an extent that they start suffering from important tension type headaches. Concentrating the study and the therapy on just solving the problem of the headaches sometimes gives rise to therapeutic failure, which occasionally goes on for months. Other symptoms, such as tics, unspecific dizziness, pains in the abdomen and visual disorders, can also be the reason that brings ADHD patients to visit. CONCLUSIONS: When faced with these symptoms we should always bear in mind (mainly in the case of headaches) the possibility referred to above and special care must be taken not to diagnose ADHD in excess, and always base our judgment on objective proof that meets the criteria required for its diagnosis. Therapy based on pharmacological treatment and a suitable psychopedagogical intervention solves the problem in these cases and significantly reduces the symptomatology that led to the visit.

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INTRODUCTION: Intracranial lipomas (ICL) are congenital malformations that are due to an anomalous differentiation of the primitive meninges. AIMS: The purpose of this study is to determine the most frequent symptoms related to ICL in the paediatric age, as well as to evaluate whether they are directly related to their location and to their association with other brain malformations. PATIENTS AND METHODS: A retrospective clinico-radiological study was conducted involving 20 paediatric patients diagnosed as suffering from ICL between 1985 and 2003 at three hospitals in the Valencian Community. RESULTS: 70% of the cases were females and the average age when ICL was diagnosed was 5.3 years (interval from 2 months to 13 years). The most common initial clinical justification for the neuroradiological study was psychomotor retardation in eight patients (40%) and persistent, predominantly migrainous, headaches in six of them (30%). Only one patient was examined because of epilepsy. The prevailing site was the interhemispheric fissure in 10 patients (50%), followed by the quadrigeminal cistern in five (25%) and the mamillary body infundibulum axis in three of them (15%). One case was located in the cerebellum and another was found in the lateral ventricle, with involvement of the choroid fissure. Associated anomalies were observed in eight patients (40%). Alterations were seen in the development of the corpus callosum in six patients (30%), five in an isolated way and in one case there was partial absence of the associated septum pellucidum. Another patient was found to have an isolated partial agenesis of the septum and Goldenhar syndrome was detected in another case. The radiological follow up, which varied according to the initial clinical features, did not show any differences in the morphology or the size of the lipoma. CONCLUSIONS: 1) ICL are more frequently located in the interhemispheric fissure and in the quadrigeminal cistern; 2) In these locations they can be associated with other brain malformations, the most important being defects in the callosa and septa; 3) Most ICL were found incidentally during the course of a neuroimaging examination. Only in the case of three patients (15%) was there any presumed relation between the location of the ICL (pericallosal), the symptomatology (overall psychomotor retardation) and the associated malformation (hypoplasia of the corpus callosum); 4) The incidence of epilepsy was much lower than that claimed in earlier reports, and the predominant associated neurological symptomatology was found to be psychomotor retardation and headache (70%); 5) ICL is a developmental anomaly that does not require neurosurgical treatment and which does not usually change with the passage of time, although it is liable to increase because of adipose hypertrophy.

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Introducción. Los lipomas intracraneales (LIC) son malformaciones congénitas que se originan por una diferenciación anómala de la meninge primitiva. Objetivo. Conocer los síntomas que se relacionan más frecuentemente con los LIC en la edad pediátrica, así como valorar si tienen relación directa con su ubicación y con su asociación a otras malformaciones cerebrales. Pacientes y métodos. Se ha realizado un estudio clinicorradiológico retrospectivo de 20 pacientes pediátricos con LIC, diagnosticados entre 1985 y 2003, en tres hospitales de la Comunidad Valenciana. Resultados. El 70 por ciento de los casos son mujeres, y la edad media cuando se diagnóstico el LIC fue de 5,3 años (intervalo, de 2 meses a 13 años). La justificación clínica inicial más frecuente del estudio neurorradiológico fue retraso psicomotor, en ocho pacientes REV NEUROL 2003; 37 (6): 515-521 (40 por ciento), y cefalea persistente de predominio migrañoso, en seis (30 por ciento). Sólo un paciente se estudió por epilepsia. La localización dominante ha sido la cisura interhemisférica, en 10 pacientes (50 por ciento), seguida de la cisterna cuadrigémina, en cinco (25 por ciento), y el eje infundibulomamilar, en tres (15 por ciento). Un caso se localizó en el cerebelo, y otro en el ventrículo lateral con extensión a la cisura coroidea. Se observaron anomalías asociadas en ocho pacientes (40 por ciento). En seis pacientes (30 por ciento) se observó una alteración en el desarrollo del cuerpo calloso, en cinco de manera aislada y en uno con ausencia parcial asociada del septo pelúcido. En otro paciente se observó una agenesia parcial aislada del septo, y en otro caso se detectó un síndrome de Goldenhar. El seguimiento radiológico, variable según la clínica inicial, no mostró diferencias en la morfología ni en el tamaño del lipoma. Conclusiones. 1) Los LIC se localizan con mayor frecuencia en la cisura interhemisférica y en la cisterna cuadrigeminal; 2) En estas localizaciones pueden asociarse a otras malformaciones cerebrales, fundamentalmente defectos callosos y septales; 3) La mayor parte de los LIC representan un hallazgo incidental de neuroimagen; sólo en tres pacientes (15 por ciento) hubo una presunta relación entre la ubicación del LIC (pericallosa), la sintomatología (retraso psicomotor global) y la malformación asociada (hipoplasia del cuerpo calloso); 4) La incidencia de epilepsia ha sido mucho más baja que la descrita previamente, y se halló como sintomatología neurológica asociada predominante el retraso psicomotor y la cefalea (70 por ciento); 5) El LIC es una anomalía malformativa que no precisa tratamiento neuroquirúrgico y que no suele modificarse con el tiempo, aunque es susceptible de aumentar por hipertrofia adiposa (AU)

Introduction. Intracranial lipomas (ICL) are congenital malformations that are due to an anomalous differentiation of the primitive meninges. Aims. The purpose of this study is to determine the most frequent symptoms related to ICL in the paediatric age, as well as to evaluate whether they are directly related to their location and to their association with other brain malformations. Patients and methods. A retrospective clinico-radiological study was conducted involving 20 paediatric patients diagnosed as suffering from ICL between 1985 and 2003 at three hospitals in the Valencian Community. Results. 70% of the cases were females and the average age when ICL was diagnosed was 5.3 years (interval from 2 months to 13 years). The most common initial clinical justification for the neuroradiological study was psychomotor retardation in eight patients (40%) and persistent, predominantly migrainous, headaches in six of them (30%). Only one patient was examined because of epilepsy. The prevailing site was the interhemispheric fissure in 10 patients (50%), followed by the quadrigeminal cistern in five (25%) and the mamillary body-infundibulum axis in three of them (15%). One case was located in the cerebellum and another was found in the lateral ventricle, with involvement of the choroid fissure. Associated anomalies were observed in eight patients (40%). Alterations were seen in the development of the corpus callosum in six patients (30%), five in an isolated way and in one case there was partial absence of the associated septum pellucidum. Another patient was found to have an isolated partial agenesis of the septum and Goldenhar syndrome was detected in another case. The radiological follow-up, which varied according to the initial clinical features, did not show any differences in the morphology or the size of the lipoma. Conclusions. 1) ICL are more frequently located in the interhemispheric fissure and in the quadrigeminal cistern; 2) In these locations they can be associated with other brain malformations, the most important being defects in the callosa and septa; 3) Most ICL were found incidentally during the course of a neuroimaging examination. Only in the case of three patients (15%) was there any presumed relation between the location of the ICL (pericallosal), the symptomatology (overall psychomotor retardation) and the associated malformation (hypoplasia of the corpus callosum); 4) The incidence of epilepsy was much lower than that claimed in earlier reports, and the predominant associated neurological symptomatology was found to be psychomotor retardation and headache (70%); 5) ICL is a developmental anomaly that does not require neurosurgical treatment and which does not usually change with the passage of time, although it is liable to increase because of adipose hypertrophy (AU)

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