ABSTRACT
Introducción: La infección congénita por citomegalovirus (CMV) supone una importante causa de discapacidad. Existen escasas evidencias acerca del valor pronóstico de las lesiones presentes en los estudios de neuroimagen. Objetivo: Analizar la gravedad de las lesiones en la resonancia magnética (RM) y la ecografía transfontanelar, y su relación con déficits neurológicos a largo plazo. Pacientes y métodos: Se realizó un estudio observacional analítico retrospectivo de 36 pacientes con infección congénita por CMV. Se revisaron los estudios de neuroimagen y se clasificaron según la escala de Noyola et al. modificada. Se relacionaron los hallazgos de neuroimagen con la afectación neurológica en su última visita en la consulta de neuropediatría. Resultados: Un total de 36 pacientes fueron estudiados, habiéndose realizado ecografía transfontanelar en 30 y RM cerebral en 29. La ecografía transfontanelar estuvo alterada en 20/30 pacientes, de los cuales, 11 tuvieron alteración en la RM (p = 0,04) y 10 afectación neurológica (p = 0,008). Tuvo una sensibilidad del 83,3%, IC 90%: 58-100 y una especificidad del 44,4%, IC 90%: 18,7-70,2 para la predicción de secuelas neurológicas. La RM estuvo alterada en 20/29 pacientes. Dieciséis de ellos tuvieron afectación neurológica (p < 0,001), teniendo una sensibilidad del 94%, IC 95%: 80-100 y una especificidad del 66,6%, IC 95%: 36-97,5 para la predicción de secuelas neurológicas. Una escala de Noyola et al. ≥ 2 se asoció a retraso psicomotor (p < 0,001). Conclusión: Nuestro trabajo valida los estudios previos en los que se encuentra correlación estadísticamente significativa entre la extensión de las lesiones en neuroimagen y la gravedad de los déficits neurológicos. (AU)
Background: Congenital cytomegalovirus (CMV) infection is an important cause of disability. There is little evidence on the prognostic value of lesions identified in neuroimaging studies. Aim: The study aimed to assess the severity of lesions detected with brain MRI and transfontanellar ultrasound and their relationship with long-term neurological deficits. Patients and methods: We performed a retrospective, analytical, observational study of 36 patients with congenital CMV infection. Neuroimaging studies were reviewed and classified according to the modified Noyola scale. Imaging findings were compared with neurological alterations in the patients most recent follow-up evaluation at the paediatric neurology department. Results: Thirty-six patients were studied (transfontanellar ultrasound: 30; brain MRI: 29). Twenty of 30 patients showed ultrasound abnormalities; of these, 11 showed alterations on brain MR images (P=.04) and 10 had neurological impairment (P=.008). Transfontanellar ultrasound had a sensitivity of 83.3%, 90% CI: 58-100 and a specificity of 44.4%, 90% CI: 18.7-70.2 for predicting neurological sequelae. Brain MRI displayed abnormalities in 20 of 29 patients, of whom 16 had neurological impairment (P<.001). MRI had a sensitivity of 94%, 95% CI: 80-100 and a specificity of 66.6%, 95% CI: 36-97.5 for predicting neurological sequelae. Modified Noyola scale values >2 were correlated with psychomotor retardation (P<.001). Conclusions: Our findings validate previous studies reporting a statistical significant correlation between the extension of neuroimaging lesions and severity of neurological deficits. (AU)
Subject(s)
Humans , Child , Brain Diseases , Cytomegalovirus Infections/congenital , Cytomegalovirus Infections/complications , Cytomegalovirus Infections/diagnostic imaging , Pediatrics , Magnetic Resonance Imaging , Neuroimaging , Retrospective Studies , Ultrasonography , Prognosis , Psychomotor Disorders , Deafness , Laboratory and Fieldwork Analytical MethodsABSTRACT
BACKGROUND: Congenital cytomegalovirus (CMV) infection is an important cause of disability. There is little evidence on the prognostic value of lesions identified in neuroimaging studies. AIM: The study aimed to assess the severity of lesions detected with brain MRI and transfontanellar ultrasound and their relationship with long-term neurological deficits. PATIENTS AND METHODS: We performed a retrospective, analytical, observational study of 36 patients with congenital CMV infection. Neuroimaging studies were reviewed and classified according to the modified Noyola' scale. Imaging findings were compared with neurological alterations in the patients' most recent follow-up evaluation at the paediatric neurology department. RESULTS: Thirty-six patients were studied (transfontanellar ultrasound: 30; brain MRI: 29). Twenty of 30 patients showed ultrasound abnormalities; of these, 11 showed alterations on brain MR images (P = .04) and 10 had neurological impairment (P = .008). Transfontanellar ultrasound had a sensitivity of 83.3%, 90% CI: 58-100 and a specificity of 44.4%, 90% CI: 18.7-70.2 for predicting neurological sequelae. Brain MRI displayed abnormalities in 20 of 29 patients, of whom 16 had neurological impairment (P < .001). MRI had a sensitivity of 94%, 95% CI: 80-100 and a specificity of 66.6%, 95% CI: 36-97.5 for predicting neurological sequelae. Modified Noyola' scale values > 2 were correlated with psychomotor retardation (P < .001). CONCLUSIONS: Our findings validate previous studies reporting a statistical significant correlation between the extension of neuroimaging lesions and severity of neurological deficits.
Subject(s)
Brain Diseases , Cytomegalovirus Infections , Child , Cytomegalovirus Infections/complications , Cytomegalovirus Infections/congenital , Cytomegalovirus Infections/diagnostic imaging , Humans , Magnetic Resonance Imaging , Neuroimaging , Retrospective StudiesABSTRACT
El dolor abdominal es uno de los motivos más frecuentes de consulta en Pediatría. La asociación de una masa abdominal palpable es un hallazgo relevante que nos obliga a realizar un estudio completo de forma preferente, siendo prioritario descartar malignidad u otras complicaciones como la compresión de órganos vitales. La mayoría de los casos se corresponden con procesos benignos, siendo más frecuente este hallazgo en niños menores de 5 años. A continuación, se describen dos casos clínicos cuyo síntoma inicial fue el dolor abdominal con el hallazgo casual de una masa abdominal y diagnóstico final de patologías importantes. El primer caso se trata de un varón de 3 años intervenido de forma urgente por cuadro de abdomen agudo, en cuya cirugía se encontró una masa abdominal llegando finalmente al diagnóstico de linfangioma quístico retroperitoneal. El segundo caso se trata de un varón de 9 años con dolor abdominal de larga evolución y aumento progresivo del mismo con hallazgo de masa palpable a la exploración física, que fue diagnosticado de linfoma de Burkitt
Abdominal pain is one of the most frequent reasons for a Paediatric consultation. The association of a palpable abdominal mass is a relevant finding that forces us to preferentially carry out a complete examination, being a priority to rule out malignancy or other complications such as compression of vital organs. Most of the cases correspond to benign processes, being more frequent in children under 5 years of age. Two clinical cases of children whose initial symptom was abdominal pain with the finding of an abdominal mass and final diagnosis of serious pathologies are described below. The first case is a 3-year-old boy who underwent emergency surgery for acute abdomen, in whose surgery an abdominal mass was found and the diagnosis of retroperitoneal cystic lymphangioma was finally reached. The second case is a 9-year-old boy with long-standing, progressive increase in abdominal pain with a finding of a palpable abdominal mass on physical examination, who was diagnosed with Burkitt's lymphoma
Subject(s)
Humans , Male , Child, Preschool , Child , Lymphangioma, Cystic/diagnostic imaging , Lymphangioma, Cystic/surgery , Abdominal Pain/etiology , Abdominal Neoplasms/diagnosis , Hydronephrosis/complications , Hydronephrosis/diagnostic imaging , Retroperitoneal Neoplasms/diagnostic imaging , Diagnosis, Differential , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Congenital cytomegalovirus (CMV) infection is an important cause of disability. There is little evidence on the prognostic value of lesions identified in neuroimaging studies. AIM: The study aimed to assess the severity of lesions detected with brain MRI and transfontanellar ultrasound and their relationship with long-term neurological deficits. PATIENTS AND METHODS: We performed a retrospective, analytical, observational study of 36 patients with congenital CMV infection. Neuroimaging studies were reviewed and classified according to the modified Noyola' scale. Imaging findings were compared with neurological alterations in the patients' most recent follow-up evaluation at the paediatric neurology department. RESULTS: Thirty-six patients were studied (transfontanellar ultrasound: 30; brain MRI: 29). Twenty of 30 patients showed ultrasound abnormalities; of these, 11 showed alterations on brain MR images (P=.04) and 10 had neurological impairment (P=.008). Transfontanellar ultrasound had a sensitivity of 83.3%, 90% CI: 58-100 and a specificity of 44.4%, 90% CI: 18.7-70.2 for predicting neurological sequelae. Brain MRI displayed abnormalities in 20 of 29 patients, of whom 16 had neurological impairment (P<.001). MRI had a sensitivity of 94%, 95% CI: 80-100 and a specificity of 66.6%, 95% CI: 36-97.5 for predicting neurological sequelae. Modified Noyola' scale values >2 were correlated with psychomotor retardation (P<.001). CONCLUSIONS: Our findings validate previous studies reporting a statistical significant correlation between the extension of neuroimaging lesions and severity of neurological deficits.
