Acute Flaccid Myelitis Among Hospitalized Children in Texas, 2016.

BACKGROUND: Acute flaccid myelitis is characterized by acute-onset flaccid limb weakness with predominantly gray matter lesions in the spinal cord spanning one or more segments. Rates of full recovery are poor, and there is no standard treatment or definitive cause. METHODS: This is a retrospective review of children diagnosed with acute flaccid myelitis in Texas during 2016. Patients were identified through a Texas collaborative of six hospitals in four major metropolitan areas. Data abstraction included health history, illness presentation, medical treatments, laboratory studies, imaging data, recovery, and ability to perform activities of daily living up to approximately two years from illness onset. RESULTS: Among all sites, 21 patients met inclusion criteria. Treatments varied with the most common being intravenous immunoglobulin, high-dose methylprednisolone, and plasmapheresis. No differences were seen in response to medical treatments. A potential etiology was found in 12 (57%) cases, including four with enterovirus D68. Five cases recovered fully. Of the 16 patients without full recovery, abilities ranged from (1) able to perform all activities of daily living for age independently (n = 5), (2) mild deficits (n = 5), and (3) substantial reliance on caregivers for activities of daily living (n = 6). CONCLUSION: Many reports describe symptoms and outcomes of acute flaccid myelitis, but limited data are available on long-term functional outcomes. We were unable to make a strong case for any single cause or treatment modality. Fortunately, the majority of patients (15, 71%) were able to perform activities of daily living with complete independence or only mild deficits.

Comparing Single-Photon Emission Computed Tomography (SPECT), Electroencephalography (EEG), and Magneto-encephalography (MEG) Seizure Localizations in Pediatric Cases of Laser Ablation.

Intractable epilepsy may have a more severe effect on children in comparison to adults because the motor, sensorial, and cognitive functions of children are still undergoing development. For this same reason, however, children maintain a greater potential for recovery from intractable epilepsy because of the remaining cerebral plasticity. Thus, after 2 unsuccessful antiepileptic medications, surgical intervention is recommended. Pre-surgical localization of the epileptogenic zone increases seizure-freedom post-surgery by 200% to 300%. Single-photon emission computed tomography (SPECT) is commonly used, with magneto-encephalography (MEG) and electroencephalography (EEG), to localize the epileptogenic zone, because it localizes cerebral blood flow. There is limited research in the efficacy of SPECT localization in pediatric pharmacoresistant epilepsy. Therefore, the objective of this study was to determine the efficacy of SPECT in it's ability to localize the epileptogenic zone in laser ablation cases of pediatric pharmacoresistant epilepsy. Out of 122 SPECTs conducted at Dell Children's Medical Center from July 2010 to January 2015, 12 underwent laser ablation. In the 12 cases of laser ablation, SPECT displayed more sensitivity and specificity than EEG and more specificity than MEG when held against the laser ablation outcomes. This study further proves that SPECT is efficacious in epileptogenic zone localization of pediatric pharmacoresistant epilepsy.

Instrumented fusion in a 12-month-old with atlanto-occipital dislocation: case report and literature review of infant occipitocervical fusion.

BACKGROUND: The treatment of atlantoaxial dislocation in very young children is challenging and lacks a consensus management strategy. DISCUSSION: We review the literature on infantile occipitocervical (OC) fusion is appraised and technical considerations are organized for ease of reference. Surgical decisions such as graft type and instrumentation details are summarized, along with the use of bone morphogenic protein and post-operative orthoses. ILLUSTRATIVE CASE: We present the case of a 12-month-old who underwent instrumented occipitocervical (OC) fusion in the setting of traumatic atlanto-occipital dislocation (AOD). CONCLUSION: Occipitocervical (OC) arthrodesis is obtainable in very young infants and children. Surgical approaches are variable and use a combination of autologous grafting and creative screw and/or wire constructs. The heterogeneity of pathologic etiology leading to OC fusion makes it difficult to make definitive recommendations for surgical management.

Bilateral occipital dysplasia, seizure identification, and ablation: a novel surgical technique.

MRI-guided thermal ablation is a relatively new technique utilising heat to ablate both tumours and epileptogenic lesions. Its use against epilepsy offers some patients a new and relatively safe way of reducing or aborting seizures. Most cases of MRI-guided thermal ablation have been performed in patients with isolated lesions. Placement of depth electrodes prior to laser ablation has been rarely performed. We present a case with bilateral independent lesions traversing eloquent cortex, which, after sampling for seizures and successful ablation, retained normal function. The patient is, to date, seizure-free.

A novel route for processing cobalt-chromium-molybdenum orthopaedic alloys.

Spark plasma sintering has been used for the first time to prepare the ASTM F75 cobalt-chromium-molybdenum (Co-Cr-Mo) orthopaedic alloy composition using nanopowders. In the preliminary work presented in this report, the effect of processing variables on the structural features of the alloy (phases present, grain size and microstructure) has been investigated. Specimens of greater than 99.5 per cent theoretical density were obtained. Carbide phases were not detected in the microstructure but oxides were present. However, harder materials with finer grains were produced, compared with the commonly used cast/wrought processing methods, probably because of the presence of oxides in the microstructure.

Optic nerve and chiasm enlargement in a case of infantile Krabbe disease: quantitative comparison with 26 age-matched controls.

Hypertrophy of the optic nerves and optic chiasm is described in a 5-month-old boy with infantile Krabbe disease. Optic nerve and optic chiasm hypertrophy is a rarely described feature of Krabbe disease. The areas of the prechiasmatic optic nerves and optic chiasm were measured and compared with those of 26 age-matched controls. The areas of the prechiasmatic optic nerves and optic chiasm were 132% and 53% greater than normal, respectively.