Juvenile head trauma syndromes and their relationship to migraine.

The clinical spectrum of juvenile head trauma syndromes was derived from an analysis of 50 attacks in 25 patients. Attacks were grouped into four clinical types: (1) hemiparesis; (2) somnolence, irritability, and vomiting; (3) blindness; and (4) brain stem signs. Our evidence shows that these four types are different manifestations of a common underlying process. All attacks followed mild head trauma after a latent interval, generally of one to ten minutes. Forty of the 50 attacks occurred in patients under 14 years of age. Full recovery occurred after a variable time in all but one instance. This patient, and one other, had an angiographically demonstrable occlusion of a branch of the middle cerebral artery. In clinical and laboratory features, these attacks resemble classical migraine and presumably have a similar underlying mechanism.

Transdiaphragmatic migration of a ventriculoperitoneal catheter.

A child developed an infected hydrothorax and respiratory distress 3 years after the insertion of a ventriculoperitoneal shunt. The distal catheter had penetrated the right pleural space via retrohepatic transdiaphragmatic migration.

Trapped fourth ventricle: a report of two unusual cases.

A trapped or isolated 4th ventricle presents as a posterior fossa mass lesion. It occurs in patients with prior lateral ventricular shunting and is diagnosed by computed tomographic scan. Two unusual cases are reported here.

Trauma-triggered migraine: an explanation for common neurological attacks after mild head injury. Review of the literature.

This paper reviews the literature on complex temporary disturbances of brain function triggered by mild blows to the head in children, adolescents, and young adults. It consolidates the evidence by which these attacks have been identified as classical or complicated migraines, and provides a historical account of the descriptions and proffered explanations of these attacks. The clinical features and the electroencephalography, angiography, computerized tomography, and cerebrospinal fluid findings of trauma-induced migraine are presented and compared to those of spontaneous migraine. Ideas about the pathogenesis of this condition are related to current thinking on the neurological phenomena of migraine in general.

A variant of normal-pressure hydrocephalus simulating Pick's disease on computerized tomography. Report of two cases.

The authors present two cases of normal-pressure hydrocephalus that simulated Pick's disease radiographically and that were initially diagnosed as cortical atrophy. In both cases, Sylvian cisternoperitoneal shunts improved the clinical picture only temporarily, but ventriculoperitoneal shunting produced dramatic relief of all symptoms.

Spontaneous osteoporotic fracture of the sacrum. An unrecognized syndrome of the elderly.

Three elderly patients with incapacitating back and leg pain were found to have spontaneous osteoporotic fractures of the sacrum. The clinical picture in these three patients suggests a distinct clinical entity of spontaneous osteoporotic fracture of the sacrum (SOFS). This is characterized by severe low back, hip, and leg pain that suggests initially lumbosacral radicular compression, either from disk disease, spinal stenosis, tumor. However, objective mechanical signs more typical of those entities may be absent or minimal in SOFS. Symptoms suggestive of a cauda equina syndrome may be present, but there is minimal or no neurological deficit on examination. Marked sacral tenderness is a hallmark of SOFS.

Intracranial hemorrhage in the premature. Its predictive features and outcome.

Sixty-four infants with birth weights of 500 to 1,500 g were studied to determine the incidence and outcome of intracranial hemorrhage. Thirty-seven (58%) had hemorrhage and of these 60% died. Of the survivors, progressive hydrocephalus requiring treatment developed in only two infants. Serial computerized tomographic scans with measurement of ventricular-brain width ratios were found to be useful in objectively evaluating hydrocephalus. Review of perinatal data showed no association of maternal or obstetrical factors with neonatal hemorrhage but the infants who had intracranial bleeding showed a high incidence of low Apgar scores, respiratory distress syndrome, acidosis, hypoxia, apnea, hypotension, seizures, and requirement for respiratory support. Multiple regression analysis of potentially causative factors assigned importance to low gestational age, respiratory distress syndrome, birth asphyxia (low Apgar score), and vaginal delivery.