[Imaging in paediatric epilepsy]. / Imagerie de l'épilepsie chez l'enfant.

Epilepsy is a chronic disease, often with an onset during childhood and characterized by spontaneous and recurrent seizures. It concerns 0.5-1% of children under 16 years of age. A classification proposed by the International League Against Epilepsy (ILEA) in 2001 takes into account recent genetic factors involved in epilepsy and attenuates the sharp demarcation between generalized and partial seizures. This classification tends to define whether imaging is indicated or not. Imaging is useless in simple cases of fits associated with hyperthermia and in benign idiopathic epilepsy. It is debated if it is a first episode of epilepsy without a particular context and no neurological signs. In all other cases of epilepsy in children, imaging is indicated. In descending order of frequency the possible causes include malformations (as abnormal gyral development and phakomatoses), hypoxic-ischemic lesions, non-accidental injuries, infections, metabolic diseases and tumors. Being much more sensitive than computed tomography (CT), magnetic resonance imaging (MRI) is the technique of choice to identify an underlying cause in symptomatic epilepsy. Clinical data are mandatory in order to direct a proper MRI investigation. The recently developed diffusion-weighted sequence is particularly useful in the acute phase of certain events such as hypoxia-ischemia, trauma and metabolic disease. CT scan is used in emergency situations and also as a complement to MRI for example to identify calcified lesions. In this way, imaging contributes to establish the nature and define the extension of epileptogenic lesions, thereby guiding therapeutic management. MRI also allows follow-up of the consequences of repeated seizures (such as mesial temporal sclerosis and selective neuronal necrosis) on the cerebral parenchyma and plays a role in the establishment of a prognosis.

[Headache in childhood: which diagnostic imaging strategies?]. / Céphalées chez l'enfant: quand et quelle imagerie?

There are various causes of headaches in children. The majority of cases are considered as primary and include migraine and tension headaches. Headaches secondary to an underlying pathology are much less frequent. The aim of imaging will be to depict lesions that can benefit from specific therapy and hence improve life quality and expectancy of the affected child. In case of secondary headaches, imaging will have to precise the diagnosis, which is based mainly upon history of the disease and clinical findings. These findings are important to the radiologist as they will help to choose the more adequate technique between CT scan and MRI. This choice is based upon the presumed diagnoses, degree of emergency and availability of the technique. Knowledge of the differential diagnoses influences the way to perform the examination itself (choice of slice thickness, plane of imaging, MR sequences, need for an MR angiogram or injection of contrast medium...). In our opinion, dedicated MR imaging is the technique of choice to investigate secondary headaches in children given its superior sensitivity in depicting certain tumors (glioma of the pons, posterior fossa tumors...), intracranial hypotension, Chiari I malformation, lesions of the hypothalamo-hypophyseal axis etc...

[Atypical presentation of an intestinal duplication in a three month old child]. / Présentation atypique d'une duplication intestinale chez un enfant de trois mois.

Intestinal duplication is an uncommon congenital anomaly that often is diagnosed during childhood. Ultrasound diagnosis is based on the presence of a characteristic double-walled cystic mass. We report a case of duplication in a three Month old child presenting with small bowel obstruction. This case is unusual due to the presence of calcifications that are uncommon in intestinal duplication.

[Diagnostic imaging in non-accidental brain injuries]. / Pictorial essay. Imagerie dans les traumatismes craniens non-accidentels.

Diagnosis of nonaccidental injury (child abuse) may be difficult because most infants present with non-specific clinical findings and without external signs of trauma. Brain lesions severely disproportionate to the history of trauma, retinal hemorrhages and characteristic fractures or fractures of varying age are key indicators to child abuse when encountered in an infant. It is therefore incumbent upon the radiologist to recognize the radiologic findings of the various forms of nonaccidental injury and to correlate them with the physical findings in order to render a more accurate opinion. Craniocerebral injuries are not uncommon in infants who are physically abused and have a worse long-term outcome than accidental injuries. The particularities of the infant's skull and its content and the pathophysiology of cerebral nonaccidental injuries are remembered. The imaging findings in infants with blunt impact, shaken- and whiplash shaken-injuries are emphasized. The combination of edema, malignant hyperaemic cerebral swelling, hypoxic-ischemic brain injury, diffuse axonal injuries, and bilateral and/or interhemispheric subdural hematomas is almost typical of a shaken infant. MRI, with its multiplanar capability and its sensitivity to cytotoxic edema and to degraded hemoglobin, is the modality of choice for detecting cerebral lesions in nonaccidental injury.