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Biomedical subjects

R A Minns

Publications and source records attributed to R A Minns.

At least 37 records · Page 2Linked to original sources
PubMed1998

A retrospective epidemiological analysis of non-accidental head injury in children in Scotland over a 15 year period.

A retrospective analysis of the epidemiological characteristics of non-accidental head injury (NAHI) in children in Scotland over the last fifteen years from 1981 until March 1996 was performed. The information was provided by the Information and Statistics Division of the Scottish Health Service. The average incidence of NAHI calculated over this period was 0.04 cases per year per 1000 children under 5 years. Fifty-five per cent of all cases occurred in those children who were less than a year old. 41% of cases were inflicted by a parent but in 47% the perpetrator could not be identified. The mortality rate was found to be 2%. Non-accidental head injury cases identified using the ICD-9 coding classification system gives a surprisingly low incidence. This number is probably an underestimate and the reasons for this are discussed. A prospective epidemiological analysis of NAHI in children in Scotland is being undertaken to determine the true incidence.

Adolescent↗
PubMed1997

Neurobrucellosis in childhood: six new cases and a review of the literature.

Neurobrucellosis accounts for <1% of cases of brucellosis in children. Six new cases of neurobrucellosis are presented and data from 39 previously published cases are analysed. The incidence is equal in males and females, and the source of infection is likely to be unpasteurised milk. Clinical presentation varies from severe meningoencephalitis or peripheral neuropathy/radiculopathy to behavioural disturbance. Diagnostic certainty requires isolation of the organism from the CSF, but as this is rarely possible serological diagnosis can be performed with the Coombs test on the CSF. Treatment requires combination antibiotic therapy and should continue for at least 8 weeks.

Animals↗
PubMed1995

Intracranial pressure and cerebral arterial flow velocity indices in childhood hydrocephalus: current review.

Because of its noninvasive and repeatable nature, Doppler ultrasound has been increasingly used to assess changes in cerebral haemodynamics in infants and children with hydrocephalus. There is general agreement that a direct correlation exists between the intracranial pressure (from experimental, fontanometric and direct measurement evidence) and the resistance index. In addition, this increasing index has been predominantly due to a reduction in the end-diastolic velocity. Stable ventriculomegaly is associated with normal pulsatility. The cerebral blood flow velocity parameters change significantly following CSF drainage by tapping or shunting. The measurement of intracranial pressure and cerebral blood flow velocity are currently the best ways of assessing the need for CSF diversion and monitoring subsequent shunt function.

Blood Flow Velocity↗
PubMed1994

Hypothalamic hamartoma with skeletal malformations, gelastic epilepsy and precocious puberty.

A child is described who has skeletal malformations, gelastic epilepsy, precocious puberty and a hypothalamic hamartoma. The skeletal abnormalities were detected at birth, she developed gelastic epilepsy at the age of 3 years 5 months and precocious puberty at 3 years 8 months. A hypothalamic hamartoma was found on MRI. The precocious puberty has been successfully medically managed, though her seizures are difficult to control. The combination of all four features has not been described previously.

Bone and Bones↗
PubMed1994

Psychosis or epilepsy--a diagnostic and management quandary.

MB suffered an episode of status epilepticus of febrile origin at the age of 20 months. This was followed at two years by complex partial seizures of temporal lobe origin and at eight years he had learning difficulties arising from the dominant hemisphere. Subsequent symptoms included auditory, visual and olfactory hallucinations which were not controlled by antipsychotics or antiepileptics. EEG and MRI were unhelpful and alternating diagnoses of schizophrenia and temporal lobe epilepsy were made. Now aged 17 years, he has a diagnosis of schizophreniform psychosis with temporal lobe abnormality from status epilepticus in childhood, and is managed by an adult psychiatrist. His symptoms persist.

Adolescent↗
PubMed1993

Temporal and spatial parameters of gait in children. I: Normal control data.

A study of the spatial and temporal parameters of gait was performed on 134 normal children, 68 boys and 66 girls, aged between three and 18 years. Normal gait showed a clear asymmetry; gait was considered to be abnormally asymmetrical if differences between left and right measurements exceeded 8 to 10 per cent. In addition, there was a definite bias comparing left and right sides, which may relate to individual laterality.

Adolescent↗
PubMed1993

Temporal and spatial parameters of gait in children. II: Pathological gait.

Temporal and spatial parameters of gait were measured in 72 children with anomalous walking patterns as a result of neuromuscular impairment, 21 with childhood hemiplegia, 27 with congenital paraplegia and 24 with miscellaneous neuromotor disorders. Measurements were compared with those for a group of normal children. In all three groups, step length, average maximum foot-velocity and walking speed were reduced, double support time was increased, while cadence deviated from normal in both directions. Hemiplegic children varied considerably in their measured side-to-side gait asymmetries, suggesting a range of gait abnormalities not specified by subjective means alone. Measured gait parameters were significantly related to Hoffer grade of functional mobility in paraplegic children. Objective gait analysis using established temporal and spatial measurements is of clinical value in the management of childhood neuromuscular disorders.

Adolescent↗
PubMed1993

Cerebral blood flow velocity monitoring in pyogenic meningitis.

Transcranial Doppler ultrasound monitoring of cerebral blood flow velocity (CBFV) was performed on 17 children (age range 8 days to 6 years) with pyogenic meningitis. Serial measurements of the peak systolic, end diastolic, mean flow velocity, and resistance index (equal to peak systolic velocity minus end diastolic velocity divided by peak systolic velocity) were obtained over the period of their hospital admission. In all 16 survivors there was a significant decrease in the final resistance index compared with the initial resistance index due to a significant increase in the end diastolic velocity. There was a significant increase in the final mean flow velocity. In four patients the decrease in intracranial pressure and increase in cerebral perfusion pressure after mannitol infusions was accompanied by a corresponding decrease in resistance index and increase in mean flow velocity. A pressure passive CBFV response with a significant linear correlation for resistance index/mean arterial pressure may suggest a loss of cerebrovascular autoregulation. These results suggest that in the early phase increased cerebrovascular resistance may contribute to a relative impairment of cerebral perfusion. Non-invasive monitoring by transcranial Doppler ultrasound may be helpful for early detection of deterioration in cerebral haemodynamic trends.

Blood Flow Velocity↗
PubMed1993

Protein C and S deficiency causing childhood stroke.

The annual incidence of cerebrovascular disease in children is 2.5/100,000 and cerebral infarction is being increasingly recognised in neonates. Deficiency of proteins C and S and their roles in thrombosis have only recently been recognised. Immunologic and functional assays of these proteins now make it possible to determine whether deficiency of them is associated in any particular case of childhood cerebrovascular accident (CVA). We describe two patients, both presenting with stroke in childhood, who were found to be deficient, one in protein C and one in protein S.

Cerebrovascular Disorders↗
PubMed1992

Cerebrovascular resistive index assessed by duplex Doppler sonography and its relationship to intracranial pressure in infantile hydrocephalus.

Duplex Doppler sonography and direct intracranial pressure (ICP) measurement were performed on 18 patients with infantile hydrocephalus. ICP was measured through a frontal reservoir or ventricular tap using a nondisplacement pressure transducer. The Pourcelot Resistive Index, RI = (peak systolic-end diastolic)/peak systolic velocity was obtained from pulsed-wave Doppler measurements of blood flow velocity in the anterior (ACA) and/or the middle cerebral (MCA) arteries. There was a statistically significant positive correlation between ICP and RIs in the MCA and ACA. Paired RI measurements in 7 patients with raised ICP decreased significantly from a mean of 0.90 pre-tap to 0.75 post-tap. Our results suggest that the RI provides a reliable measure of cerebrovascular resistance in hydrocephalus. Duplex Doppler ultrasonography thus is a useful noninvasive means of monitoring cerebrohaemodynamic change with simultaneous imaging of ventricular size in infantile hydrocephalus.

Blood Flow Velocity↗
PubMed1992

Cerebral blood-flow velocity and intermittent intracranial pressure elevation during sleep in hydrocephalic children.

The clinical importance of intermittent intracranial pressure (ICP) elevations during sleep in hydrocephalic children is unclear. Eight studies of continuous ICP monitoring with simultaneous cerebral blood-flow velocity (CBFV) measurements were recorded during sleep in seven hydrocephalic children aged between one and 10 years. ICP was measured directly through a frontal reservoir. There were two main patterns of CBFV change in response to raised ICP: a progressive decrease in mean flow velocity and increase in resistance index, suggesting impaired haemodynamic compensation to ICP elevation due to reduced circulatory reserve in patients with limited intracranial compliance; and an increase in mean flow velocity with raised ICP, suggesting that appropriate haemodynamic compensation with increased blood-flow can occur to maintain adequate cerebral perfusion in those with sufficient circulatory reserve. Simultaneous CBFV and ICP measurements may help to identify those with reduced circulatory reserve who are at greater risk of ischaemic insult from episodic increases in ICP.

Blood Flow Velocity↗
PubMed1991

Cerebral blood flow velocity changes after ventricular taps and ventriculoperitoneal shunting.

Transcranial Doppler ultrasonography (TCD) was performed on 14 patients with hydrocephalus (age range 1 day to 12 years old) before and after ventriculoperitoneal shunting. TCD was also performed with simultaneous intracranial pressure (ICP) measurements during ventricular taps through a reservoir in 7 patients. Measurements of the resistance index (RI) = (S-D)/S, peak systolic (S), enddiastolic (D) and time-averaged mean flow velocities were made. After ventricular taps and ventriculoperitoneal shunting there was a significant decrease in RI in all patients. This was due to a greater increase in D compared to S, which suggests a decreased distal cerebrovascular resistance. There was a significant correlation between RI and ICP in the older infants and children and in individual neonates. Successful cerebrospinal fluid diversion reduces ICP and cerebrovascular resistance, thus improving cerebral perfusion. The RI is a reliable index for serial monitoring of cerebrohaemodynamic change in patients with hydrocephalus.

Blood Flow Velocity↗
PubMed1991

Transcranial Doppler (TCD) ultrasound as a noninvasive means of monitoring cerebrohaemodynamic change in hydrocephalus.

Cerebral blood flow velocity (CBFV) measurements by Transcranial Doppler (TCD) ultrasound were performed on 27 patients with hydrocephalus (Group I: neonates, Group II: children). Simultaneous measurements of direct ICP and CBFV were performed during ventricular taps in 16 patients. There was a significant correlation between ICP and Resistance Index (RI = peak systolic-end distolic/peak systolic velocity) overall in Group II patients (p less than 0.02) and in individual neonatal patients (p less than 0.001). After ventricular taps and ventriculo-peritoneal shunting (17 patients) there was a consistent significant decrease in RI due to increased end diastolic velocity in all patients (p less than 0.001). This suggests the RI is a reliable index of cerebrovascular resistance for serial monitoring in individual patients. There was an exponential pattern of decay in RI with CSF volume depletion (volume-flow velocity response) in 50/56 taps which allows calculation of a volume-buffering reserve before perfusion change occurred. Simultaneous ICP/CBFV monitoring during sleep may help to identify patients who are unable to compensate haemodynamically during episodic increase in ICP and are a greater risk of ischaemic insult. TCD is a useful noninvasive technique of monitoring cerebrohaemodynamic change for initial assessment and further management of children with hydrocephalus.

Adolescent↗
PubMed1989

Neuro-developmental study of profoundly mentally handicapped children in hospital care.

Swedish estimates of the need for long-term intensive health care provision for profoundly mentally handicapped children were compared with an Edinburgh survey, and the neurodevelopment and health characteristics of Edinburgh children with profound mental handicap who required prolonged admission are described. The extent of their disabilities indicates the complexity of the task of designing alternatives to their present hospital provision which will adequately meet their health needs.

Abnormalities, Multiple↗
PubMed1989

Symptoms and signs of progressive hydrocephalus.

The clinical features of 107 cases of children with hydrocephalus and measured raised intraventricular pressure were analysed retrospectively. Fifty one children had recently been diagnosed as having hydrocephalus, and the remainder had had shunts injected to direct the cerebrospinal fluid. The most common symptoms in the group were vomiting, behavioural changes, drowsiness, and headaches. The most common clinical signs were inappropriately increasing occipitofrontal head circumferences, tense anterior fontanelles, splayed sutures, and distension of the scalp veins. Half the infantile cases of hydrocephalus were without symptoms, and a quarter of the cases with cerebrospinal fluid shunts and measured raised intraventricular pressure were without signs. There were no fewer than 33 different clinical signs including several unusual ones, such as macular rash and sweating. We believe that the presentation of hydrocephalus with raised intraventricular pressure is sufficiently variable, unusual, or even absent to justify the direct measurement of intracranial pressure.

Cerebrospinal Fluid Shunts↗