Pediatric neurology
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Pediatric neurology · Jan 2011
Case ReportsTolosa-Hunt syndrome preceded by facial palsy in a child.
We report on a previously healthy 11-year-old boy with unilateral periorbital mild headache and facial nerve palsy, followed during the next 5 months by recurrent unilateral headaches and subsequent extrinsic paresis of the third cranial nerve and paresis of the sixth cranial nerve, each of which improved with steroids. Cranial magnetic resonance imaging revealed increased thickening of the left cavernous sinus and adjacent structures, with marked gadolinium enhancement. ⋯ Recurrent multiple cranial neuropathies, neuroimaging findings, and long-lasting headache that responded to steroids indicated Tolosa-Hunt syndrome, further confirmed by extensive investigation and a long follow-up to exclude other causes. This patient illustrates the complexity of disorders with multiple cranial nerve palsies, and adds to the sparse literature on Tolosa-Hunt syndrome in children, describing the first pediatric case preceded by facial palsy.
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Pediatric neurology · Dec 2010
Case ReportsDandy-Walker malformation: a rare association with hypoparathyroidism.
Dandy-Walker malformation is characterized by cystic dilatation of the fourth ventricle and an enlarged posterior cranial fossa with upward displacement of the tentorium, lateral sinuses, and torcular, with agenesis or hypoplasia of the cerebellar vermis. Dandy-Walker malformation occurs in approximately the 4th week of gestation and is associated with various abnormalities involving the cardiac, skeletal, genitourinary, and gastrointestinal systems. ⋯ Reported here is the case of a male infant with Dandy-Walker malformation with ventricular and atrial septal defect, unilateral renal agenesis, and hypoparathyroidism. To our knowledge, this rare association with neural crest events during the development of Dandy-Walker malformation has not been reported previously.
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The objective of the present study was to estimate the prevalence and relative risk of symptoms suggestive of childhood periodic syndrome in migraine, migraine subtypes, and tension-type headache, relative to control subjects. The target population was all children (age 5-12 years) enrolled in public elementary schools in one Brazilian city (n = 2173). Consent was obtained for 1994 children; analyzable data were available for 1906 children, for a final sample of 1113 children with migraine, tension-type headache, or no headache. ⋯ For tension-type headache, only nocturnal enuresis and motion sickness were not more common than in controls. In multivariate analyses, any interictal symptom was independently associated with any headache (P < 0.001), migraine headaches (P < 0.001), and tension-type headaches (P < 0.01). These findings indicate that interictal symptoms suggestive of childhood periodic syndromes are common in the population, and are associated with migraine and specific migraine subtypes, but also with tension-type headache.
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Pediatric neurology · Dec 2010
Case ReportsHenoch-Schönlein purpura in a child with Guillain-Barré syndrome.
A case of Henoch-Schönlein purpura with Guillain-Barré syndrome in a 3-year-old-girl is presented. This association is extremely rare. ⋯ In the present case of Henoch-Schönlein purpura complicated by Guillain-Barré syndrome, the factor XIII level was measured, a novel feature of this study. The findings suggest the involvement of factor XIII, which is characteristically involved in Henoch-Schönlein purpura, also is involved in the associated Guillain-Barré syndrome.
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Pediatric neurology · Nov 2010
Experience with botulinum toxin type A in medically intractable pediatric chronic daily headache.
In adults, botulinum toxin type A has been studied as a potentially effective treatment for chronic daily headache. For pediatric chronic daily headache, the literature evaluating efficacy of botulinum toxin type A is sparse, with no studies assessing tolerability. The purpose of this retrospective case series study was to assess tolerability and efficacy of botulinum toxin type A in the treatment of pediatric chronic daily headache. ⋯ The four responders noted improvements in quality of life. Three patients experienced minor adverse events from botulinum toxin type A. This case series suggests that botulinum toxin type A can be well tolerated and may be a useful therapeutic in pediatric patients with highly medically intractable chronic daily headache.