[Rare epileptic crisis symptom: vomiting].
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Biomedical subjects
Publications and source records attributed to J L Nivelon.
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Looking for frequency of somnambulism in 3 homogeneous groups of children, a first group of migrainous children, a second group of epileptic children and a third group of normal children, the authors have observed that an antecedent of somnambulism existed in 28% of migrainous children, when it was found in only 6% of epileptic children, and in 5% of normal children. This significant difference demonstrates that the association of migraine and somnambulism is real. The possibility that migraine and somnambulism appearing in the same patient at different ages might be the expression of a same neurochemical disorder is discussed. The practical interest to know this association is that somnambulism may be a real clinical marker of migrainous background that should be searched for in every patient presenting with chronic cephalalgia.
The second child of a non consanguineous couple had a male phenotype with two intrascrotal testes of normal size however a scrotum bifidum was noted. The karyotype of the child was 46 XX and the parents one's was normal. No Y specific sequence was detected by using four Y specific probes (47 B, 12 F3, 52 D and 118). During the first semester of life, hormonal investigations showed a normal testicular function.
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In six children, aged from 8 to 12 years, presenting with primary generalized epilepsy a significant rise in plasma ACTH and prolactin levels (as compared with levels measured 5 days later) was observed either during a generalized seizure demonstrated by EEG (3 cases) or within 1 hour of a generalized seizure (3 cases). The neurophysiological basis for these post-epileptic endocrine disturbances is a sudden depression of dopaminergic and GABA-ergic pathways. As a result, these endocrine changes, already well documented in adults, may be regarded as a good biological marker of the epileptic origin of a paroxysmal attack.
The authors present the second case in the literature of Dandy-Walker malformation associated with occipital meningocele and congenital cardiac defect. This association suggests that the time of origin of this posterior fossa malformation is before the sixth postconception week; however, the pathogenesis remains unsettled.
A method for bone age calculation for neonates is reported. Criteria for maturation and growth are separately analysed. The chosen X ray charts were thorax including mandibula and profile of the right leg. 126 neonates 28 to 41 weeks of gestational age were studied. A linear regression is given. An area of confidence for growth and maturation for each gestational age has been designed. When gestational age is known, it gives the opportunity to appreciate the impact of a given pathology on these 2 data.
The authors compare the effects of treatment with thyroid extracts and levothyroxine on T3, T4 and TSH levels in 2 groups of 8 hypothyroid infants. Serum TSH levels were lower in infants receiving thyroid extracts on and after the 15th day. The interest of a treatment associating T4 and T3 and of adapted doses of LT4 is discussed.
A prospective study was carried out among 190 low birthweight neonates (less than 2,500 g) in order to assess their ratio of total body fat by 2 adiposity indices: Weight/Height3 (W/H3) at birth and Weight/Height2 (W/H2) subsequently. Adequate for gestational age (AGA) girls with weight indices (W/H3) above the 10th percentile (AGA/I+) had a lower height than AGA/I- girls on the 6th (p less than 0.01) and 9th (p less than 0.05) months of corrected chronological ages. Mean weight and height of small for gestational age (SGA) neonates with weight indices (W/H3) lower than the 10th percentile (SGA/I-) were similar to the SGA/I+ as soon as 3 months of corrected chronological age. SGA/I+ infants experienced a progressive increase in low weight indices (W/H2) until 15-18 months without significant differences with SGA/I- at 3, 6, 9 months of corrected chronological age. Meanwhile, low indices (W/H2) were more frequently observed in SGA/I- at 15-18 months. Thus the early characteristics in weight indices disclose a lower ratio of body fat in SGA infants than in normal children, at least up to age 15-18 months.
In an infant considered at birth as a female but with easily palpable gonads in the labia major, the XY karyotype and the endocrine studies (determination of plasma levels of steroid hormones under basal conditions and during hCG stimulation) were consistent with the diagnosis of male pseudohermaphroditism due to 17-keto reductase deficiency. During the second pregnancy an amniocentesis revealed a 46 XY karyotype. Endocrine studies performed on the amniotic fluid at midgestation suggested that the fetus was affected by the same enzyme defect. After birth, the diagnosis was demonstrated with anatomical an endocrine studies.
The case reported concerns a child presenting with systemic lupus erythematosus (SLE) with acute neurological symptoms who improved after plasma exchanges. The value of plasma exchange in patients with SLE remains unclear. It seems to be useful for acute and severe neurological impairments in patients already receiving high dose corticosteroid therapy.
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A heparin-induced case of thrombocytopenia occurring in an adolescent is reported. Its physiopathology and treatment are discussed. Complications are not only bleeding, but also arterial or venous thrombosis. Usually, stopping of heparin therapy is necessary, but sometimes the treatment should be followed with low molecular weight heparin.
The authors show the interest of near-nerve recording of sensory action potentials in children less than 3 years old. This technique provides precious information for the morphology and amplitude of sensory potentials. Normal values are calculated from the median and the tibial nerve of control subjects.
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About one case of skull injury in a infant, brain ultrasonography potency is underlined. This technic allowed to diagnose a subdural hematoma which was inapparent clinically and by complementary investigations.
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From 3 cases reports, the authors emphasize the importance of acute confusional migraine in childhood. It is more frequent than in adulthood and it is often the presenting problem making the diagnosis more difficult.