The Many Faces of Neurological Neonatal Herpes Simplex Virus Infection.

This case series explores the various manifestations of central nervous system (CNS) involvement in neonatal herpes simplex virus (HSV) infection and highlights the challenges involved in their diagnosis and treatment. Neonatal HSV infection is a rare but serious condition that can have significant neurological consequences. The article presents three cases of neonatal HSV infection, all involving the CNS, each characterized by distinct clinical features and outcomes. Case 1 describes a three-week-old male with severe HSV meningoencephalitis resulting in poor response to treatment and death. Cases 2 and 3 describe younger neonates who presented early in the disease course with disseminated infection and skin, eye, and mouth (SEM) lesions. Although both patients had CNS involvement, their outcomes were remarkably favorable. The wide range of clinical presentations of CNS manifestations in neonatal HSV infection, ranging from nonspecific to evident neurological symptoms, underscores the need for a high index of suspicion and comprehensive evaluation to ensure early diagnosis and appropriate treatment. However, it also notes that even with timely treatment, some cases may still have a poor prognosis.

Clinically Isolated Syndrome and Frontal Lobe Arteriovenous Malformation Presenting With Behavior Issues.

Prevalence of brain arteriovenous malformation ranges from 0.14% to 0.6% according to various estimates. A large number of these patients remain asymptomatic. The most common presentation is due to brain hemorrhage. A 14-year-old girl presented to the pediatrician with erratic behavior issues and hallucinations. She was diagnosed by the pediatrician and mental health facility as having schizophrenia and bipolar disorder. Once she was transferred to our children's hospital, evaluation by a pediatric neurologist, computed tomography scan, magnetic resonance imaging, and laboratory workup including lumbar puncture confirmed a clinically isolated syndrome and frontal lobe arteriovenous malformation. Frontal lobe lesions including arteriovenous malformation in the frontal lobe can cause psychological symptoms and behavioral issues. We also discuss the differential diagnosis of acute demyelinating syndromes.

Safety and diagnostic efficacy of gadoteridol for magnetic resonance imaging of the brain and spine in children 2 years of age and younger.

BACKGROUND: Neonates and young children require efficacious magnetic resonance imaging (MRI) examinations but are potentially more susceptible to the short- and long-term adverse effects of gadolinium-based contrast agents due to the immaturity of their body functions. OBJECTIVE: To evaluate the acute safety and diagnostic efficacy of gadoteridol (ProHance) for contrast-enhanced MRI of the central nervous system (CNS) in children ≤2 years of age. MATERIALS AND METHODS: One hundred twenty-five children ≤2 years old (including 57 children <6 months old) who underwent contrast-enhanced MRI of the CNS with gadoteridol at 0.1 mmol/kg body weight were retrospectively enrolled at five imaging centers. Safety data were assessed for acute/subacute adverse events in the 48 h following gadoteridol administration and, when available, vital signs, electrocardiogram (ECG) and clinical laboratory values obtained from blood samples taken from 48 h before until 48 h following the MRI exam. The efficacy of gadoteridol-enhanced MRI compared to unenhanced MRI for disease diagnosis was evaluated prospectively by three blinded, unaffiliated readers. RESULTS: Thirteen changes of laboratory values (11 mild, 1 moderate, 1 unspecified) were reported as adverse events in 7 (5.6%) patients. A relationship to gadoteridol was deemed possible though doubtful for two of these adverse events in two patients (1.6%). There were no clinical adverse events, no serious adverse events and no clinically meaningful changes in vital signs or ECG recordings. Accurate differentiation of tumor from non-neoplastic disease, and exact matching of specific MRI-determined diagnoses with on-site final diagnoses, was achieved in significantly more patients by each reader following the evaluation of combined pre- and post-contrast images compared to pre-contrast images alone (84.6-88.0% vs. 70.9-76.9%; P≤0.006 and 67.5-79.5% vs. 47.0-66.7%; P≤0.011, respectively). CONCLUSION: Gadoteridol at 0.1 mmol/kg body weight is safe, well tolerated and effective for contrast-enhanced MRI of the CNS in children ≤2 years of age.

Allergic fungal rhinosinusitis presenting with intracranial spread along large sphenoidal emissary foramen.

A 13-year-old girl was admitted for headache, right periorbital swelling and erythema. CT imaging demonstrated right orbital preseptal cellulitis, severe pansinusitis and suspected epidural abscess. Brain MRI and sinus CT confirmed an epidural abscess in the right middle cranial fossa and a second extra-cranial abscess in the right infratemporal fossa along with large right sphenoidal emissary foramen. Drainage from sinus surgery confirmed allergic fungal rhinosinusitis. She was treated with prednisone and voriconazole.

Techniques that decrease or eliminate ionizing radiation for evaluation of ventricular shunts in children with hydrocephalus.

Shunted hydrocephalus in children is a commonly seen diagnosis in hospitals throughout the world and is one of the most common chronic pediatric neurosurgical conditions. These children undergo numerous studies for routine surveillance as well as for evaluation of shunt malfunction, many of which are associated with significant radiation exposure over the child׳s lifetime. It is in the child׳s best interest to minimize the overall exposure to ionizing radiation so as to decrease the chance of the deleterious effects from occurring. The article outlines the epidemiology of ventricular shunt catheters, the typical indications and methods for shunt evaluation, and the preferred alternative imaging methods that eliminate or reduce radiation exposure.

Imaging findings in 512 children following all-terrain vehicle injuries.

BACKGROUND: Injuries related to all-terrain vehicle (ATV) use by children have increased in recent years, and the pattern of these injuries is not well known among radiologists. OBJECTIVE: Our purpose was to identify different radiologically diagnosed injuries in children suffering ATV-related trauma and determine associations among various injuries as well as between injuries and outcome. MATERIALS AND METHODS: The study included 512 consecutive children suffering from ATV injuries treated at a tertiary care pediatric hospital. All imaging studies were reviewed and correlated with injury frequency and outcome using multivariate analysis. RESULTS: Head injuries occurred in 244 children (48%) and in five of six deaths. Calvarial skull fractures occurred in 104 children and were associated with brain, subdural and epidural injuries. Brain and orbit injuries were associated with long-term disability. A total of 227 extremity fractures were present in 172 children (34%). The femur was the most commonly fractured bone. Nine children had partial foot amputations. Multiorgan injuries occurred in nearly half of the 97 children with torso injuries. Determinants for long-term disability or death were head injuries (odds ratio 3.4) and extremity fractures (odds ratio 3.3). CONCLUSION: Head and extremity injuries are the two most common injuries in children suffering ATV injuries and are associated with long-term disability. ATV use by children is dangerous and is a significant threat to child safety.

Tricuspid valve magnetic resonance imaging phase contrast velocity-encoded flow quantification for follow up of tetralogy of Fallot.

Our purpose was to identify E- and A-wave flow patterns across the tricuspid valve in tetralogy of Fallot (TOF) patients following repair using magnetic resonance imaging phase contrast velocity-encoded flow quantification and to correlate them with measurements of right ventricle enlargement. The study included 33 children following TOF repair who had MRI examinations that included cine imaging to quantify ventricle size and function and flow analysis across the atria-ventricular valves to evaluate ventricle in-flow patterns. The E:A ratio was calculated for each patient and the population separated into alpha (E:A ratio > or = 1.4) and beta (E:A ratio < 1.4) groups. Significant association was present between the beta group and right ventricle end diastolic volume index > or =140 ml/m(2) (P = 0.046), right ventricle end systolic volume index > or =70 ml/m(2) (P = 0.02), and end diastolic volume right ventricle to left ventricle > or = 2.0 (P = 0.003). A reduction in the E:A wave ratio across the tricuspid valve is associated with right ventricle diastolic dysfunction and correlated well in our study with right ventricle enlargement. This may be a useful criterion for determining the timing of valved pulmonary conduit surgery in children following TOF repair.