Not "Polle syndrome", please.
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Child Abuse↗
Biomedical subjects
H M Strassburg
Publications and source records attributed to H M Strassburg.
Ultrasonographic diagnosis of brain tumors in infancy.
Fourteen intracranial tumors were diagnosed by means of mechanical sector scanning through the infant's open fontanelle in a series consisting of 1150 examinations. In addition, integrated pulsed Doppler-sonography (duplex-scan technique) was used to diagnose malformations of intracranial vessels. We established five diagnostic criteria: high echogenic structures are mostly seen in solid tumors of the periventricular region; low echogenic structures are seen in infiltrating tumors of the cerebral tissue and they are difficult to recognize; echo-free structures correspond with a cystic process, a necrosis or malformation of vessels; indirect sonographic signs of a cerebral tumor are all changes in shape and size of the normal anatomic structures; and abnormal blood-perfusion of a marked region, e.g. caused by dilatations of vessels, can be proved by integrated pulsed Doppler-sonography.
Brain Neoplasms↗
[Noninvasive intracranial pressure measurement at the anterior fontanelle in the first days of life].
A continuous registration of intracranial pressure by aplanation-tonometry on the anterior fontanelle was performed in 12 healthy term newborns during the night hours of the first 3 days. The median intracranial pressure of the first day was 4.01 +/- 2.74 cm H2O. There was a slight increase between the first and the second day of life and a significant increase between second and third day up to 5.84 +/- 2.66 cm H2O. In our interpretation this result is a sign for the active reconfiguration of the skull by increasing intracranial pressure, which may be a consequence of changing tonus of cerebral vessels.
Cranial Sutures↗
[The cavum septi pellucidi and cavum Vergae in infants -- an investigation with 2-dimensional sector-echo encephalography].
Using a two-dimensional sector-scanner the brains of 642 preterm and term infants between 28 weeks of gestation and 12 months of age were examined for the incidence of a cavum septi pellucidi (CSP) and a cavum Vergae (CV). In 100 out of 642 infants we saw a CSP. The highest incidence (52%) was found among the infants of very low gestational age (-33 weeks) within the first seven days of life. After the second month the incidence decreases rapidly (only 1% in infants - months). We saw a CV only in combination with a CSP, less frequent, however, than a CSP alone (26 out of 642 infants): the incidence was 33% in infants of very low gestational age (-33 weeks) within the first seven days of live, only 4% in term neonates and 0% after the second month of life. Finally, the rupture of a septum with CSP and CV by stretching forces is demonstrated in an infant with progressive hydrocephalus. The data of this paper contribute to the knowledge of the morphological development of the normal fetal and newborn brain.
Age Factors↗
[Morphological demonstration and identification of an aneurysm of Galen's vein in infants by the duplex scan technique (author's transl)].
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Cerebral Angiography↗
[How to diagnose intracranial haemorrhages in infants by two-dimensional ultrasound scanning (author's transl)].
Applying a rotatory sector-scanner, in 437 infants between the 29th gestational week and 18th month of life, a sonographic study was performed in order to look for an intracranial haemorrhage. The recording was performed real-time, using the anterior fontanelle as an acoustic window. In 42 infants we saw signs of an intracranial haemorrhage, which was confirmed 11 times anatomically and 11 times by CAT. Advantages and disadvantages of the method are discussed.
Cerebral Hemorrhage↗
[Doppler-sonography of cerebral blood-flow in infants].
Doppler-sonography of the intracranial arteries in the sagittal section through the open anterior fontanelle may yield valuable information on the cerebral blood-flow in infants. Applying the directional method, the anterior-cerebral artery could be recorded in all probands; by using the pulsed technique at least one artery was identified in 95% of the cases. There was a significant difference in pulsation-index (P.I.) between the pulsed and the directional method. Both methods revealed a reduction of the P.I. in infants with brain edema, and an increase of the P.I. after intracranial haemorrhage had occurred. The P.I. was significantly increased in infants younger than 36 gestational weeks, compared with healthy term newborns older than 40 weeks. The clinical relevance for diagnostic purposes as well as for therapeutic monitoring is discussed.
Brain Edema↗
Diagnosing hydrocephalus in infants by ultrasound sector scanning through the open fontanelles. A study comparing ultrasound-sonography and CAT-scan.
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Female↗
The late facilitation in H-reflex recovery cycles in different pyramidal lesions.
H-reflex amplitudes were recorded after stimulation of the tibial nerve and different electrical stimuli in 18 normal persons and 26 patients showing pyramidal spasticity (8 spastic spinal paralysis, 6 spastic hemiparesis, 12 spinal lesions). A just subthreshold stimulus of the tibial nerve facilitated the H-reflex in spastic patients slightly after about 300 ms (up to 113%), following an early strong facilitation (10 ms) and a longer lasting depression (20-200ms). Similar postinhibitory facilitation was obtained in spastic patients after ipsilateral stimulation of the plantar surface and after direct stimulation of the dorsal columns. Conditioning by contralateral stimuli of the posterior tibial nerve caused a slight late facilitation in both normal and spastic patients. This late facilitation did not correlate significantly with the severity of spasticity, but it was more pronounced in cerebral pyramidal lesions than in spinal ones. It is assumed that this postinhibitory facilitation is probably generated as a spinal rhythm, similar to the clonus, and that it is modulated from supraspinal structures.
Adolescent↗
[Henoch-Schoenlein purpura (author's transl)].
Routine EEG investigations and observance of discrete neurological and psychological symptoms in 13 children in the acute phase of Henoch-Schoenlein purpura showed that involvement of the central nervous system in this disease is the rule rather than the exception. Capillary resistance was reduced in 51 out of 76 investigated children. On the other hand a reduction in factor XIII activity was much less commonly found (n =6). Immune complex determination in 28 children, together with antibody studies, showed that in 13 of them the Henoch-Schoenlein purpura was triggered off by an influenza-A-virus infection of the upper respiratory tract. Two thirds of the patients had markedly raised levels of total serum complement which fell weeks within several.
Adolescent↗
Mesencephalic chronic electrodes in pain patients. An electrophysiological study.
Early components of lemniscal potentials after contralateral median nerve or mechanical stimulus are due to lemniscal pathways, whereas later components, after 70 msec appearing bilaterally and at higher stimulus intensities probably express extralemniscal activity. Evoked potentials in the central gray matter show much smaller amplitudes compared with somatosensory cortical evoked potentials (SSEP). The strongest component is a negative wave after 70--100 msec. Longer conditioning stimulation of the lemniscal system inhibits late components in the median nerve evoked cortical potentials. On the contrary, stimulation of the nonspecific periaqueductal gray matter produces inhibition of early components of cortical SSEP together with facilitation of late components.
Afferent Pathways↗
Influence of transcutaneous nerve stimulation (TNS) on acute pain.
Using transcutaneous nerve stimulation (TNS) simple surgical procedures such as tooth extractions and nerve biopsies can be performed without the usual anesthetics. Estimation of threshold and suprathreshold intensities of painful electrical stimuli show no significant change during TNS. Only the threshold for non-painful electrical stimuli is slightly increased. Cortical potentials evoked by electrical peripheral nerve stimulation are not significantly modulated by TNS. Latencies of the early components 0, I--III are unchanged, the amplitudes only slightly reduced. These observations are in contradiction to the 'gate-control' theory of pain.
Acute Disease↗
Influence of dorsal column stimulation (DCS) on spastic movement disorders.
Dorsal column stimulation in two spastic patients with upper motor neurone disease showed the following effects: 1. The subjective feeling of stiffness decreased. During DCS patients were able to walk longer distances without rest. 2. The ability to perform fast alternating or synchronous "pedal-pressing" foot movements improved by 15%. 3. The threshold of H-reflexes was enhanced up to 12%, and outlasted the end of stimulation by two minutes. 4. The H-reflex amplitude was depressed in relation to intensity and duration of DC-stimulation up to 10 minutes after the end of DCS. 5. A late second facilitatory wave at 300 msec in the curve for H-reflexes conditioned by a short tibial stimulus was inhibited during DCS. Although the hyperexcitability of the H-reflex was dampened significantly during DCS the whole motor disturbance improved only slightly.
Adult↗
[Arterial catheterism and Doppler sonographic registration of blood flow in infancy].
Catheterization of certain arteries offers the possibility of very helpful continuous arterial monitoring in intensive care patients. The lower risk of thromboembolic complications and advantages in disaster or operative situations favored punction of larger arterial vessels, e.g. A. axillaris. We advise the use of Doppler-sonography blood flow measurements for arterial catheterism and catheter control in pediatric intensive care. By a case report this technic is described and recommended in percutaneous axillary artery cannulation and surveillance of possible occlusive catheter complications.
Axillary Artery↗
[Craniocerebral dysproportion--a contribution to the significance of extracerebral fluid collections in infancy].
By cranial ultrasound extracerebral fluid collections with a thickness of more than 5 mm were diagnosed in 101 infants under 1 year of age (jan. 84-dec. 85). Well-known etiologic factors were found in many cases (subdural hygroma, bacterial meningitis, shunt-dysfunction, congenital malformations, ACTH-therapy). In 38 children with normal clinical and neurological aspect no definite cause could be detected. In case of normal head circumference we consider this state as a variation of the norm. In case of macrocephalus (greater than 97th percentile) we propose the terminus "cranio-cerebral dysproportion". Possible etiologies, diagnostic procedures and differential diagnosis are discussed. The knowledge of this benign condition is important to prevent children from unnecessary diagnostic and therapeutic procedures.
Atrophy↗
[Prognostic value of cerebral angiography].
After a 5 years' experience of cerebral sonography (about 4,500 recordings) in infants we are trying to establish correlations between alterations of anatomical structures and the further clinical development. Obviously there is no constant connexion between a simple subependymal haemorrhage and the further neurological symptoms. At the age of two and more years, about 30% had a normal state, the other part had very different clinical signs. Even an uncomplicated ventricular haemorrhage had no definite influence on the child's development in most cases. Ischemic infarctions seem to have a better prognosis than borderline-infarctions. Real intracranial cysts and slight brain atrophy seem to have only distinct neurological symptoms. Porencephalic defects or brain necrosis, e.g. after parenchymatous haemorrhages and infarctions as well as generalized hypoxic encephalopathies with increased echogenicy and progressive brain atrophy nearly always showed neurological defects, though the dimension of the brain's alteration does not clearly correlate to the clinical symptoms and the child's development. It is not possible to make a prognostic evaluation by cerebral sonography in hypoxic-ischemic brain-lesions within the first 3 weeks post partum. A more exact judgement will be given after further regular sonographic observations in all high-risk infants within the first year. Beyond this, technical and organisation-improvements will probably allow a more exact statement in future.
Brain↗
[Sonographic position and functional diagnosis of ventricular positioned shunt systems in infants with hydrocephalus].
By cranial sonography through the open fontanelles of infants with hydrocephalus a diagnosis of position and function of ventricular shunts is possible. A malposition of the ventricular catheter was diagnosed sonographically in 11 of 55 patients after primary shunting. Complications after shunting as overdrainage or shunt insufficiency could be demonstrated early and reliable. Controls in due course are diagnostically important. The number of computerized tomographies in infants with hydrocephalus can be reduced significantly. In order to reduce complications after shunting an intraoperative sonographical control of catheter position is intended.
Cerebral Ventricles↗
[The tethered cord syndrome].
The "tethered cord syndrome" as a complication of spinal dysraphism is probably more important than assumed earlier. An abnormally low position of the conus medullaris is caused by different anomalies: e.g. adhesions, lumbosacral lipoma, tight filum terminale. In some patients no skinny changes can be detected. A "tethered cord syndrome" should be considered, if neuromuscular skeletal changes as club-foot, scoliosis, muscular atrophy of disturbances of gait, sensibility or function of bladder and rectum are recognized. It is also a result of a inadequately operated meningomyelocele. For experienced examiners sonography is an interesting non-invasive diagnostic procedure during infancy. The diagnosis should be completed by spinal computerized tomography and myelography. Surgery should be performed prophylactically. The "tethered cord syndrome" is explained by case histories of the University Hospital of Children, Freiburg.
Child, Preschool↗