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Fetal surgery
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Emily A. Partridge, Alan W. Flake
The Eurofetus trial was a multicenter randomized controlled trial that compared serial amnioreduction to SLPC for TTTS. The laser therapy group had higher survival of at least one fetus to at least 28 days of age, 76% versus 56% in the amniocentesis group. In addition, the laser group had a higher mean gestational age at delivery, with an average of 33 versus 29 weeks in the amniocentesis group. Most importantly, at 6-month follow-up, the laser group had improved neurologic outcomes, with a decreased risk of periventricular leukomalacia.
Cytomegalovirus
Published in Avindra Nath, Joseph R. Berger, Clinical Neurovirology, 2020
CMV is the most frequent infectious cause of birth defects, with up to 40,000 infected infants born annually in the United States. Thus, about 1% of babies born in the United States have CMV infection acquired in utero, as evidenced by shedding of virus in the urine or saliva [20]. The vast majority of these babies are asymptomatic at birth, but the remaining 5%–10% have potentially devastating symptomatic cytomegalic inclusion disease [7,21]. Pathologic examination of the brain in cases of congenital infection will reveal ventriculoencephalitis. Neuropathologic findings may include cerebral necrosis or periventricular leukomalacia.
Brain Injury and Infant Cardiac Surgery: Overview
Published in Richard A. Jonas, Jane W. Newburger, Joseph J. Volpe, John W. Kirklin, Brain Injury and Pediatric Cardiac Surgery, 2019
Periventricular leukomalacia, the most common of the lesions observed in affected infants on follow-up study, is characterized neuropathologically after a few months by multiple small cystic areas of necrosis, dorsal and lateral to the external angle of the lateral ventricle.18,19 After many months to a year or more, the cysts may disappear as they are obliterated by an astroglial scar. However, most striking is a marked deficiency of cerebral white matter with a resulting large lateral ventricle. This deficiency of myelination results not only because of the focal periventricular necrosis but also because the acute lesion involves, in addition, more diffuse injury to the differentiating oligodendroglia in the white matter of these infants. The result is an impairment of myelination, because the oligodendroglia are necessary for subsequent myelination of the cerebral white matter.
Goal-oriented locomotion in children with spastic diplegia: Anticipatory orienting strategies and trajectory formation
Published in Developmental Neurorehabilitation, 2022
Alexander Castilla, Alain Berthoz, Giovanni Cioni, Vittorio Belmonti
No statistically significant difference was found between AL and IL, for none of the parameters studied, according to the Mann–Whitney test. However, a sole subject with CP demonstrated behavior that varied between the two walking conditions. This subject could walk only when accompanied; when unaccompanied he remained frozen, unable to start. As shown in Table 1, he walked at slow speed, head anticipation was early and wide (long AT and wide HHDmax), while trajectory curvature (CI) was normal. This subject was a 13.4-year-old male with a mild intellectual disability and a prominent perceptual disorder. MRI indicated extensive bilateral periventricular leukomalacia involving mostly the parietal and frontal lobes, associated with bilateral damage to the thalami and the posterior limb of the internal capsule (PLIC).
Severe Craniofacial Involvement due to Amniotic Band Sequence
Published in Fetal and Pediatric Pathology, 2018
Luis Eduardo Becerra-Solano, Gema Castañeda-Cisneros, Jorge Roman Corona-Rivera, Manuel Díaz-Rodríguez, Luis Eduardo Figuera, Eunice López-Muñoz, José Antonio Nastasi-Catanese, José Jesús Toscano-Flores, María de Lourdes Ramírez-Dueñas, José Elias García-Ortíz
A 2-month-old male was evaluated due to cleft lip, cleft palate and several additional malformations. The patient was the product of healthy and non-consanguineous 26-year-old parents. The family history included unilateral ulnar and radial hypoplasia in an older sister and a maternal female first cousin. During the third month of gestation, a urinary tract infection and abortion threat occurred. The patient was delivered after a full-term pregnancy by cesarean section due to fetal distress and hydrocephaly. At birth, facial cleft and left frontal encephalocele were present in addition to constrictive scars on the limbs resulting in severe deformities on the left-side extremities. For clinical data and illustration, see Figure 3 and Table 1. The patient was evaluated by neurologists due to cerebral malformations and frontal leukomalacia. He was also evaluated by cardiologists due to persistent foramen ovale. X-rays of the thorax showed fusion of the seventh and eighth right ribs and hemivertebra in the eighth dorsal vertebra (Figure 3). Patient was lost to follow up.
An update on clinical, pathological, diagnostic, and therapeutic perspectives of childhood leukodystrophies
Published in Expert Review of Neurotherapeutics, 2020
Mahmoud Reza Ashrafi, Man Amanat, Masoud Garshasbi, Reyhaneh Kameli, Yalda Nilipour, Morteza Heidari, Zahra Rezaei, Ali Reza Tavasoli
Some special characteristics in brain MRI can also help to narrow the list of differential diagnoses. For example, cystic changes mostly seen in anterior temporal lobe are associated with AGS, MLC, RNASET2 deficient leukoencephalopathy, and mitochondrial encephalopathies [109–113]. This feature can also be detected in congenital cytomegalovirus infection as an acquired white matter disease [111]. Cystic white matter degeneration (cystic rarefaction) in imaging is another special characteristic and can be observed in VWM, mitochondrial leukoencephalopathies, AxD, and incontinentia pigmenti in neonates [114–117]. Periventricular leukomalacia and acute cortex degeneration in neonates are instances of acquired white matter disorders with this imaging feature [118].