[Posterior reversible encephalopathy syndrome in children with hematological diseases]. / Sindrom zadnei obratimoi entsefalopatii u detei s zabolevaniyami sistemy krovi.

OBJECTIVE: To assess risk factors (RF) and severity grade of Posterior reversible encephalopathy syndrome (PRES) in children with hematological diseases. MATERIAL AND METHODS: We analyzed cases of PRES in children during chemotherapy (CT) and after allogeneic hematopoietic stem cell transplantation (allo-HSCT). We estimated the following RF: arterial hypertension, steroid therapy, CT, immunosuppressive therapy (IST), infection and renal injury. RESULTS: Thirty-five cases of PRES occurred in 32 patients (8 after allo-HSCT and 27 during CT) were included in this study. In the most of cases (94.3%), there were 2 and more RF. An increase in blood pressure level (88.6%), CT and IST (82.8%) administration, steroid therapy (71.4%) were the most significant for PRES development. Infectious process and the decline in renal function played a lesser role in this syndrome (31.4% and 14%). At the initial presentation of PRES, there were seizures (94.3%), a decrease of consciousness (28.6%), headache, vision disturbances and stomachache (20%). In the most of cases (91.4%), the 2nd and 3d grade according to the Common Terminology Criteria for Adverse Events (CTCAE 5.0) were observed. Brain magnetic resonance imaging (MRI) revealed the vasogenic edema of temporal (88.6%), occipital (74.3%), frontal (40%) lobes and the cerebellum (22.9%) more often than the cytotoxic edema (p=0.03). The cytotoxic edema was observed in the thalamus and the basal ganglia (2.9%) more often than in other parts of the brain (p<0.01). CONCLUSION: The majority of PRES cases are caused by more than two RF. Arterial hypertension does not have a leading role among its causes. There is a significant correlation between the grade of PRES according to CTCAE 5.0 score and RF number (p<0.05).

[Stroke in children: experience of the Center for the Treatment of Cerebrovascular Diseases in Children and Adolescents in Moscow]. / Insul't u detei: opyt raboty Tsentra po lecheniyu tserebrovaskulyarnykh zabolevanii u detei i podrostkov Moskvy.

OBJECTIVE: To analyze the work of the Center for the Treatment of Cerebrovascular Pathology in Children and Adolescents, operating on the basis of the Morozov Children's City Clinical Hospital of the Moscow Health Department for the period 2018-2021 and to assess the peculiarities of organizing the provision of specialized care to children and adolescents with acute cerebrovascular accident (ACA). MATERIAL AND METHODS: Annual reports of the Center for the period 2018-2021; included children and adolescents aged 1 month to 17 years 11 months 29 days, with new onset ischemic stroke (IS) and hemorrhagic stroke (HS), cerebral venous thrombosis (sinus thrombosis), confirmed clinically and radiologically. RESULTS: Statistical data on stroke and organization of care for children with this pathology in Moscow are presented. The incidence of IS in Moscow for the period 2018-2021 ranged from 1.6 to 2.5 per 100.000 children, HI - from 2.35 to 3.3 per 100.000, sinus thrombosis from 0.5 to 1.38 per 100.000. When assessing the main etiological factors of stroke in The Center for International Pediatric Stroke Research categories, we noted a prevalence of chronic head and neck diseases (20-37%) and chronic systemic conditions (conditions or diseases with known changes in coagulation or vascular structure, including connective tissue dysplasia, genetic, hematological, inflammatory or diseases of the immune system) (15-20%). In addition, data on reperfusion therapy carried out at the Center are presented. From 2018 (first thrombolysis was performed) to 2021, 7.3-14.7% of all patients with IS underwent thrombolysis. CONCLUSION: The experience of functioning of the Center for the Treatment of Cerebrovascular Pathology in Children and Adolescents has shown that the creation of such centers in the regions of the Russian Federation is relevant, but requires taking into account the characteristics of the pediatric population when organizing their work.

[Stroke in children and adolescents]. / Insul't u detei i podrostkov.

OBJECTIVE: A comparative analysis of symptoms in arterial ischemic and stroke-like conditions in children, the development and analysis of the «Presumptive stroke in children¼ scale for prehospital diagnosis of ischemic strokes in children. MATERIAL AND METHODS: This article analyzes cases of emergency hospitalization of children in a stroke center with suspected cerebrovascular pathology as well as the symptoms of patients with suspected ischemic stroke, compares the leading and final diagnoses, identifies the main «mimics¼ of stroke and their symptom complexes. A comparison of the obtained data with the results of previous studies was carried out. RESULTS: The results show the prevalence of motor disorders and coordination disorders in cases of ischemic stroke and cerebral symptoms in cases of stroke-like conditions in children. The most frequent stroke-mimic is migraine. Based on the results of the study, we propose a screening scale for pre-hospital diagnosis of ischemic stroke in children. A preliminary assessment of the effectiveness of the scale using examples of cases of confirmed stroke and stroke-mimic was performed. CONCLUSION: Timely hospitalization of children with stroke can not only reduce mortality, but also use modern diagnostic and treatment methods to reduce the volume of brain damage with a possible complete restoration of motor and cognitive functions. Further analysis of the sensitivity and specificity of the «Presumptive stroke in children¼ scale is required.

[Pre-hospital diagnosis of stroke in children. An analysis of the work of the First aid station in Moscow and the primary pediatric stroke center]. / Dogospital'naya diagnostika insul'tov u detei. Analiz raboty sluzhby skoroi meditsinskoi pomoshchi Moskvy i pervichnogo tsentra po lecheniyu tserebrovaskulyarnoi patologii u detei i podrostkov.

OBJECTIVE: The article presents an analysis of pre-hospital diagnosis of stroke in children. MATERIAL AND METHODS: Pediatric Stroke Center of Morozov Children's City Clinical Hospital (Center) for the period from October 2018 to December 2019, 502 cases of hospitalization of children by the First aid Station to the Center with directing diagnoses of ischemic stroke (IS), haemorrhagic stroke (HS), transient ischemic attack (TIA), vertebrobasilar syndrome (VBS) were analysed. RESULTS AND CONCLUSION: TIA was the most prevalent diagnosis made by the First aid station, with the lowest rate of confirmation after further examination in the hospital (7.8%). The higher rates of confirmation were observed for VBS (31.5%), IS (11.2%) and HI (9.1%). The so-called «masks of stroke¼ were diagnosed in 84.3% cases of hospitalizations that was in line with earlier studies, which reported 50 to 93%. Based on the data on the frequency of symptoms, their combinations and specificity, a screening scale for pre-hospital diagnosis of stroke in children was suggested.

[Sturge-Weber syndrome in children. Clinical features, diagnosis and approaches to therapy on the example of three clinical cases]. / Sindrom Shturge-Vebera u detei. Osobennosti kliniki, diagnostiki i podkhodov k terapii paroksizmal'nykh sostoianii na primere trekh klinicheskikh nabliudenii.

Sturge-Weber syndrome belongs to the group of phacomotoses and is characterized by a combined lesion of the skin, eyes, nervous system and internal organs. The clinical course of Sturge-Weber syndrome is quite diverse. Of particular interest in the practice of pediatric neurology and neurosurgery is the fact that 72-90% of patients present with epilepsy. Of particular difficulty is the differential diagnosis of epileptic seizures and stroke-like episodes. The article presents clinical cases of patients with Sturge-Weber syndrome of various ages with epileptic seizures and transient ischemic attacks.

[Stroke in children and adolescents: a formation of a pediatric register]. / Insul't u detei i podrostkov: formirovanie pediatricheskogo registra.

AIM: To optimize a system of medical care, introduction of treatment and diagnostic guidelines, including secondary stroke prevention and rehabilitation measures, by implementation of pediatric stroke registry. MATERIAL AND METHODS: Fifty-seven patients, aged from 1 year to 17 years 11 months, included into the Moscow city registry of pediatric stroke were examined. Forty-two patients suffered ischemic stroke and 15 hemorrhagic stroke. RESULTS AND CONCLUSION: The diagnostic search for the causes of pediatric stroke is difficult due to the wide variety of etiologic factors and high frequency of their combinations. This confirms the necessity of multidisciplinary approach to the management of children and adolescents in the acute phase of stroke in a multiprofile hospital with the following specialized ambulatory care.

[Developmental dysphasia and epileptiform EEG activity in children]. / Narusheniia razvitiia rechi u detei i épileptiformnaia aktivnost' na ÉÉG.

Objective. To study the electrical activity of the brain in children with developmental dysphasia (alalia). Material and methods. We analyzed the EEGs of 65 children with developmental dysphasia, including 48 boys and 17 girls, aged from 3 to 4 years 11 months. General speech underdevelopment (GSU) of the 1st level (with active vocabulary less than 15-20 words) was found in 31 children and GSU of the 2nd level (with active vocabulary of 20-50 words) - in 34 children. To specify the changes in the brain electrical activity, we conducted video-EEG-monitoring during sleep and waking states in 27 patients. Results. Focal epileptiform EEG changes with no concomitant paroxysmal symptoms were recorded in 12,3% of children with dysphasia. The epileptiform activity was more frequent in GSU of the 1st level (5 (16.1%) patients) than in GSU of the 2nd level (3 (8.8%) patients). Benign epileptiform discharges of childhood with low index were identified in 2 (6,5%) children with GSU of the 1st level and in1 (2,9%) child with GSU of the 2nd level; low index spike-waves were recorded in 3 (9,7%) children with GSU of the 1st level and in 2 (5,9%) with GSU of the 2nd level. Conclusion. The data allow to clarify the frequency of epileptiform EEG activity in those children with developmental dysphasia, who do not have autism or history of seizures. The differential diagnosis with rare epileptic encephalopathies is needed, such as epilepsy with electrical status epilepticus during slow sleep (ESES) and Landau-Kleffner syndrome.

[Clinical signs of occipital cortex dysfunction in children].

Cases with epileptiform EEG-changes, which are not associated with epileptic seizures and clinical signs of epileptic encephalopathy, are frequent in practical child neurology. We present the results of examination 52 children with abovementioned changes. The high frequency of migraine was found in families of these children as well as the association between EEG-changes and earlier traumatic brain injury and other diseases that impact brain maturation.