External ventricular drainage for treatment of rapidly progressive posthemorrhagic hydrocephalus.

Twenty-seven newborn infants (birth weight, 1503 +/- 776 g; gestational age, 31 +/- 3 wk) (mean +/- standard deviation) with rapidly progressive posthemorrhagic hydrocephalus and increased intracranial pressure were treated by external ventricular drainage. The progression of hydrocephalus was arrested during the drainage period in each patient. The drainage was kept in place for 23 +/- 9 days, the longest drainage period being 48 days. In 16 of 23 surviving patients, progressive ventricular dilation recurred after removal of the drainage, requiring a definitive shunt implantation (nine ventriculoatrial, seven ventriculoperitoneal). For the remaining seven infants, no further therapy was necessary. Implantation of the permanent shunt was done days 28 to 88 (body weight, 2400 +/- 950 g). Bacterial cultures from cerebrospinal fluid and/or the tip of the ventriculostomy catheter were negative in 175 instances and positive in 11 instances (7 patients). No clinical or biochemical evidence of ventriculitis was noted. Four of the 27 patients died of causes unrelated to external ventricular drainage. Twenty-three infants survived. Seventeen of 23 survivors suffered from intraventricular hemorrhage Grade 3; in 7, neurological and developmental outcomes were classified as normal; 9 patients experienced mild to moderate paresis and/or mild to moderate developmental delay; and only 1 patient was severely retarded. Six patients with parenchymal lesions had severe motor and/or developmental handicaps. We consider external ventricular drainage an effective and safe therapy in newborn infants with rapidly progressive posthemorrhagic hydrocephalus and increased intracranial pressure. The ultimate outcome, however, depends mainly on the mode and the extent of the primary brain lesion.

[Dissociation of maturity: a typical variant of motor development (author's transl)]. / Reifungsdissoziation. Eine typische Variante der statomotorischen Entwicklung

71 cases are described of a typical variant of motor development, characterized by dissociation of maturity between the upper and the lower extremities. The affected children develop head and trunk control at the normal time, as well as skill in the use of their arms and hands, but they refuse to stand and walk well into their second year of life. Further characteristic features of this developmental type are: slender limbs generalized reduction of muscular tonus with well-preserved strength and lively spontaneous movements, mental irritation with temper tantrums and stereotype movements. Intellectual development is normal or moderately retarded. The following causes are discussed: constitutional and genetic factors (girls predominate), cerebral damage and treatment with hip abduction splints. The developmental type simulates cerebral palsy, chiefly spastic diplegia. There are only rare descriptions of this condition in the literature. Precise diagnosis is of practical importance, since despite similarities to spastic diplegia, the theurapeutic consequences are quite different. The prognosis of "dissociation of motor development" is good, at least with regard to the neurological symptoms. Normal standing and walking are achieved at the latest by the end of the second year of life. the prognosis of intellectual development depends on the cause and should be individually assessed.

[External ventricle drainage in newborn infants with rapidly growing posthemorrhagic hydrocephalus]. / Externe Ventrikeldrainage bei Neugeborenen mit rasch wachsendem posthämorrhagischem Hydrozephalus.

14 newborn infants (birth weight: 1830 +/- 930 gms, gestational age 33 +/- 4 wks) (mean +/- SD) with rapidly progressive posthaemorrhagic hydrocephalus and increased intracranial pressure were treated by means of external ventricular drainage. Progression of hydrocephalus was arrested during the drainage period in each patient. The drainage was kept in place for 20 +/- 12 days, the longest drainage period being 48 days. 8 of 10 surviving patients showed recurrence of progressive ventricular dilatation, 5 required a ventriculoatrial and 3 a ventriculoperitoneal shunt. The other 2 infants required no further therapy. Implantation of a permanent shunt was performed at day 28 to 88 after delivery, at the time of implantation the weight of the infants was 2400 +/- 950 gms (lowest weight 1650 gms). Bacterial cultures of ventricular liquor were negative in 66 and positive in 7 instances. Clinical and biochemical evidence of ventriculitis was absent in all patients. 4 of the 14 patients died of causes unrelated to external ventricular drainage. 10 infants survived. 7 out of 10 survivors suffered from IVH 3; 6 subsequently showed normal neurological development and one was retarded. 3 patients with parenchymal lesions (2 patients: IVH 4, 1 patient: primarily intraparenchymal haemorrhage) had neurological handicaps. We consider external ventricular drainage to be an effective form of therapy in newborn infants with rapidly progressive posthaemorrhagic hydrocephalus and increased intracranial pressure because this treatment achieves prompt and sustained decrease in intraventricular pressure without complications.

[Incidence of minimal cerebral palsy among students in elementary schools and special schools for speech disorders]. / Häufigkeit minimaler Zerebralparesen unter Volks- und Sprachheilschülern.

Minimal cerebral palsy (min. CP) can be diagnosed by a motoscopic neurological procedure. Two groups were tested: 1) 402 second year pupils of elementary school, aged 7; 6 to 8; 6 years, 2) 192 pupils of a special school for children with speech disturbances, preschool groups and pupils from the 1st to the 4th year of elementary school. Among the first group (n = 402) a frequency of 9.5% for min. CP was found. 17.7% were border line cases, 72.9% normal. Teachers asked to point out children with obvious motor disability identified 89.4% of the cases with min. CP; but considered only 9.8% of the neurologically normal children as having motor dysfunction. In the second group (n = 192) min. CP was found in 21.3%. The highest percentage was found in preschool classes: 63.1%.

[Motoscopic-neurological and motometric investigation in children with speech disturbances (author's transl)]. / Motoskopisch-neurologische und motometrische Paralleluntersuchung von 192 Sprachheilschülern.

According to the definition of Wigglesworth and Köng it is possible to diagnose minimal cerebral palsy (mcp) by a motoscopic-neurological (m.n.) investigation. This is based on the observation of pathological patterns of posture and movement seen in all severities of cerebral palsy. In cases of minimal cerebral palsy the test needs special experience and is considerably time consuming. The aim of this study was to demonstrate whether a motometric test--the Körperkoordinationstest für Kinder (KTK) Schilling, 1974--that is short, standardised and easy to handle, can identify children with mcp as having a low Motor Quotient (MQ) and children who are neurologically normal as having a high MQ. 192 pupils of the special school of children with speech disturbances in Vienna were investigated both with the m. n. test and the KTK. Children with a MQ greater than or equal to 86 mainly (statistically significant) belonged to the group "m. n.-normal" and children with MQ less than or equal to 85 mainly belonged to the group with the diagnosis mcp. However, it was not possible in the individual case to identify mcp with the motometric test. There were 29,3% of children with mcp who had a normal MQ and 26,9% of children with a normal m. n. test who had a MQ less than or equal to 85.

[Heredo familial areflectoric dystasie. Roussy-Lévy-Syndrome (author's transl)]. / Hereditäre Areflektorische Dystasie. Roussy-Lévy-Syndrom

The Roussy-Lévy-Syndrome in a 12 years old girl is described and its relation to other heredofamilial ataxias is discussed. The kindred of our patient was studied as well. Information about 21 family members could be collected; 11 of them also suffered from RLS. Additionally for the first time in literature, dermatoglyphic patterns in these patients have been investigated.