[Neonatal cyanosis due to fetal hemoglobin M-Osaka]. / Cyanose néonatale due à une hémoglobine fœtale M-Osaka.

The case of a newborn with isolated neonatal cyanosis on day 1 is reported. The basic investigations were sufficient to reach the diagnosis. A rare abnormal fetal hemoglobin was isolated. The prognosis of this disease is excellent and self-resolving.

Migraine with visual aura in developing age: visual disorders.

Visual disorders are an important symptom in the migraine of developing age. Different kinds of visual disturbances can precede, accompany or follow a migraine attack. These visual disturbances can be grouped into negative (hemianopsia, quadrantopsia, scotoma) and positive (phosphene, teicopsia, metamorphopsia, macropsia, micropsia, teleopsia, diplopia, dischromatopsia, hallucination disturbances) disorders. The pathogenetic mechanism of the visual phenomena of migraine has not yet been clarified. Various hypotheses have been proposed: vasospasm with consequent ischemia of some cerebral areas, the opening of arteriovenous shunts between the intra and extra cerebral circulation, the formation of microthrombi in arterioles and dopaminergic hypersensitivity of some nervous centers. We have studied 1787 children, affected by migraine with (13%) or without (87%) aura. Among the patients, 211 (12%) referred visual disorders, especially scotoma and phosphene. These data let us hypothesize that a relationship between migraine and visual disorders is present also in pediatric age. However this relationship is less important than in adults.

Fever: a novelty among the symptoms accompanying migraine attacks in children.

Our casistic of 1787 children with headache, is made up of 943 males (53%) and 844 females (47%) aged 3-14 years. 1724 had primary headache. To make a precise diagnosis of primary headache, all the children have been subjected to a rigorous anamnesis, physical and diagnostic examination (blood, urine test, head x-rays-scans, sight test with cat's eyes). Symptoms that frequently accompany headache are: phono-photophobia, (47%), pallor (43%) nausea (41%) vomit (31%) intolerance to movement (40%) and fever (9%). We especially focused on fever which presented together with migraine in 156 (9%) of the 1724 subjects examined. Headache is an important syndrome and frequent in early childhood. Actually the hypothesis used to explain the etiopathogenetic mechanism is based on a disregulation of the neurotransmitters like serotonin, catecholamine and the prostaglandins.

Sleep disorders.

Sleep disorders occupay an important position among the pathologies which may precede the appearance of headache. Some authors consider sleep disorders an expression of a functional, biochemical and/or neurotransmission alteration at central nervous system level. Sleep disorders may be distinguished, according to the Association Sleep Disorders classification in: alteration of the sleep-awake cycle, hypersomnia, parasomnia, insomnia. We observed 1876 normal children ranging from 3 to 14 years of age, 1073 (60.4%) of whom presented sleep disorders. Few studies have been carried out on the incidence of sleep disorders on casistics of healthy children. Date reported in literature state that sleep disorders do not exceed 25% of cases that is not more than one child out of four presents sleep disorders. This percentage is much lower than the 60.4% rate observed by us in children suffering from primary headache. Our results stress the importance of sleep disorders as a cephalalgic risk factor.

Evaluation of anxiety and depression in childhood migraine.

Childhood migraine can be the expression of an unconscious attempt of the small patient to show a discomfort which is denied through the defence of somatization. We considered a sample of 73 children, 39 males and 34 females suffering from migraine. We evaluated the presence of emotional disorders through diagnostic interviews consisting of one by one submission of the Anxiety Scale Questionnaire for Evolutive Age and the Children Depression Scale Test. Within our sample we are able to distinguish three groups: a first group negative for both anxiety and depressive disorders, thus defined as control group; a second group presenting anxiety depressive disorders and a third one presenting a mostly depressive symptomatology. We found a significantly higher incidence of migraine in male firstborn children belonging to the group with a condition associated to anxiety and depression.