Objective: To alert pediatricians to the neurologic consequences of toxocariasis and to describe the first pediatric case of neurotoxocariasis with concomitant cerebral, cerebellar and peripheral nervous system involvement. Description:We report a case of neurotoxocariasis in a previously healthy 5-year-old boy with unusual symptoms and multi-site involvement of both the central and peripheral nervous system. Differential diagnoses are discussed and the relevant literature is reviewed. Since the early 1950s, fewer than fifty cases have been described, mostly in adult patients. Comments:Although human toxocariasis is one of the most common zoonotic helminth infections, neurotoxocariasis is a rare condition, especially in pediatric patients. Although toxocariasis usually presents as a self-limiting disease with no central nervous system involvement, when it does occur, it can be devastating. Neurotoxocariasis should be added to the differential diagnosis of pediatric patients with unusual neurologic symptoms accompanied by high levels of eosinophils in the cerebrospinal fluid. Early diagnosis and treatment can prevent long-term neurologic sequelae.J Pediatr (Rio J). 2010;86(6):531-534: Pediatrics, nervous system, toxocariasis. ResumoObjetivo: Alertar a comunidade pediátrica às consequências neurológicas da toxocaríase e descrever o primeiro caso pediátrico de neurotoxocaríase com acometimento simultâneo do cérebro, cerebelo e sistema nervoso periférico.Descrição: Relatamos um caso de neurotoxocaríase em criança do sexo masculino, 5 anos de idade, previamente hígido, com sintomas incomuns e acometimento multifocal dos sistemas nervosos central e periférico. Discutimos o diagnóstico diferencial e fazemos uma breve revisão da literatura. Desde o início da década de 1950, menos de 50 casos de neurotoxocaríase foram descritos, a maioria em adultos.Comentários: A toxocaríase é uma das helmintíases mais comuns em humanos. A neurotoxocaríase, porém, é uma patologia rara, especialmente na população pediátrica. Embora a toxocaríase costume seguir um curso autolimitado, sem envolvimento do sistema nervoso central, as manifestações neurológicas podem ser devastadoras quando ocorrem. A neurotoxocaríase deve fazer parte do diagnóstico diferencial de pacientes pediátricos com sintomas neurológicos atípicos e eosinofilia no líquor. Se diagnosticada e tratada precocemente, é possível evitar as sequelas neurológicas a longo prazo. J Pediatr (Rio J) IntroduçãoAs parasitoses são um problema de saúde pública, sendo que algumas afetam o sistema nervoso central (SNC) 1 . A prevalência das helmintíases permanece elevada, apesar de consideráveis avanços no saneamento básico e melhor acesso à terapia anti-helmíntica 2,3 .A toxocaríase (larva migrans), transmitida ao ser humano pela ingestão de ovas de Toxocara canis ou, eventualmente, Toxocara cati, é uma das helmintíases mais comuns. Estima-se que a soroprevalência de infecção por Toxocara canis no Brasil seja da ordem de 39% em crianças de 6 meses a 6 anos de idade. São três as ...

Although rare in childhood, stroke may have a serious impact when it happens in this stage of life. Also, it may be the first sign of a systemic disease. We report 12 cases of patients with stroke treated in the Neuropediatrics Unit of Hospital de Clínicas de Porto Alegre (HCPA) from March 1997 to March 2000. All patients, from term infants to 12-year-old children hospitalized in the Pediatrics Unit of HCPA, had clinical suspicion of stroke, which was later confirmed by radiological studies. Patient follow up ranged from 1 to 6 years (mean = 3.4 years). Presenting symptoms were hemiparesis in 9 patients, seizures in 7, deviation of labial commissure in 3, and loss of consciousness in 1. The increase in the number of cases of childhood stroke identified and later confirmed by noninvasive methods had helped in the determination of different ethiologies of stroke: the most frequent being hematologic, cardiac and genetic diseases. However, our study included 6 newborns with stroke whose ethiology was not identified. Seven children with seizures received phenobarbital. Six term infants had neonatal seizures secondary to stroke and restricted to the first 72 hours of life.

-This study compared the results of neurodevelopmental examination at 6 months' corrected age of premature infants with neonatal seizures and/or intracranial hemorrhage and normal premature infants. There was a statistically significant correlation (p=0.000007) between intracranial hemorrhage and seizures in the group of 68 premature infants seen in the neurodevelopmental outpatient service at Hospital de Clínicas de Porto Alegre, Brazil. Intracranial hemorrhage was significantly associated with multiparity (p=0.02). The neurodevelopmental examination at 6 months' corrected age revealed that patients who suffered neonatal intracranial hemorrhage and/or seizures had inappropriate muscle tone, strength and reflexes, as well as delay in head control. Conclusion: we compared the results of neurodevelopmental examinations of two groups of premature infants at 6 months' corrected age. The difference in neurological development at 6 months' corrected age was statistically significant when comparison was corrected for premature infants who had neonatal seizures and periventricular hemorrhage.KEY WORDS: neurological and psychomotor development, neonates, intracranial hemorrhage, neonatal seizures. Influência da hemorragia intracraniana e crises neonatais sobre o desenvolvimento neurológico e psicomotor de recém-nascidos prematuros no Hospital de Clínicas de Porto Alegre, BrasilRESUMO -Este estudo comparou os resultados do exame do desenvolvimento neuropsicomotor aos seis meses de idade corrigida de lactentes prematuros com crises neonatais e/ou hemorragia intracraniana com lactentes prematuros sem estas intercorrências. Houve uma correlação estatisticamente significativa (p=0.000007) entre hemorragia intracraniana e crises neonatais no grupo de 68 lactentes prematuros vistos no ambulatório de neurodesenvolvimento do Hospital de Clínicas de Porto Alegre, Brasil. Hemorragia intracraniana foi significativamente associada com multiparidade (p=0.02). O exame do desenvolvimento neuropsicomotor aos 6 meses de idade corrigida mostrou que pacientes que sofreram hemorragia intracraniana neonatal e/ou crises neonatais tiveram tônus, forças e reflexos inapropriados, bem como atraso no controle do sustento cefálico. Conclusões: Comparamos os resultados dos exames de desenvolvimento neuropsicomotor dos dois grupos de lactentes prematuros aos 6 meses de idade corrigida. A diferença no desenvolvimento neurológico aos 6 meses de idade corrigida foi estatisticamente significativa quando comparado com lactentes prematuros que tiveram crises neonatais e/ou hemorragia periventricular. PALAVRAS-CHAVE: desenvolvimento neurológico e psicomotor, recém-nascidos, hemorragia intracraniana, crises neonatais.

The authors report two cases of Brazilian children with most of the common syndromic features of Proteus syndrome, such as asymmetric overgrowth of tissues, skin abnormalities, hypotonia and mental retardation. In both patients, a refractory epilepsy, compatible with Ohtahara syndrome, as well as hemimegalencephaly, with asymmetric distribution of facial fat, were also diagnosed.

-A non-controlled, prognostic cohort study was performed with the aim of establishing markers of neurological development and defining a clinical and epidemiological profile of preterm newborns at 3, 6, 9, and 12 months of gestation-corrected age in terms of parachute and lateral propping reactions. Newborns with gestational age of up to 36 weeks and 6 days, weighing 2,000 g or less at birth, were included in the study At 6 months of age, parachute and lateral propping reactions were present in 8.1% of the patients. At 9 months, the parachute reaction was present in 87.5%, and the lateral propping reaction was present in 90% of the children. It was possible to assess parachute and lateral propping reactions in preterm children in the first year of life. Alterations in trunk-limb coordination may be evidenced in the 1st year of life through postural reactions, which are maintained as prematurity markers until school age.KEY WORDS: psychomotor performance, parachute, lateral propping, preterm newborn. Reações de paraquedismo e apoio lateral em crianças prematurasRESUMO -Com o objetivo de traçar um perfil clinico-epidemiológico e estabelecer marcos do desenvolvimento neurológico de recém-nascidos prematuros aos 3, 6, 9 e 12 meses de idade corrigida, quanto às reações do paraquedismo e do apoio lateral, foi realizado estudo de coorte não controlado, com enfoque prognóstico. Foram incluídos no estudo recém-nascidos com idade gestacional até 36 semanas e 6 dias, com 2000g ou menos de peso ao nascimento. As reações do paraquedismo e apoio lateral estavam presentes em 8,1% aos 6 meses, em 87,5% e 90% respectivamente aos 9 meses. Foi possível avaliar as reações posturais do paraquedismo e do apoio lateral em crianças prematuras no periodo de um ano. Alterações na coordenação tronco-membros pode ser evidenciada no 1 o ano de vida através de reações posturais, que são mantidas como marcadores de prematuridade até a idade escolar. PALAVRAS-CHAVE: desenvolvimento neurológico, paraquedismo, apoio lateral, recém nascido prematuro.

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Objective: To alert pediatricians to the neurologic consequences of toxocariasis and to describe the first pediatric case of neurotoxocariasis with concomitant cerebral, cerebellar and peripheral nervous system involvement. Description:We report a case of neurotoxocariasis in a previously healthy 5-year-old boy with unusual symptoms and multi-site involvement of both the central and peripheral nervous system. Differential diagnoses are discussed and the relevant literature is reviewed. Since the early 1950s, fewer than fifty cases have been described, mostly in adult patients. Comments:Although human toxocariasis is one of the most common zoonotic helminth infections, neurotoxocariasis is a rare condition, especially in pediatric patients. Although toxocariasis usually presents as a self-limiting disease with no central nervous system involvement, when it does occur, it can be devastating. Neurotoxocariasis should be added to the differential diagnosis of pediatric patients with unusual neurologic symptoms accompanied by high levels of eosinophils in the cerebrospinal fluid. Early diagnosis and treatment can prevent long-term neurologic sequelae.J Pediatr (Rio J). 2010;86(6):531-534: Pediatrics, nervous system, toxocariasis.

-A sample of 51 children aged 7 with a history of prematurity was compared to 44 age-matched children who were born at term at the HCPA. The premature children had had gestational ages up to 37 weeks and 6 days and were born weighing less than 2500g. The control group consisted of children born with gestational age between 38 and 42 weeks and weights above 2S00g. The evaluation criteria were clinical examination, neurological examination and the evolutional neurological evaluation (ENE). The results pointed out that impulsiveness, aggressiveness, disorganization and enuresis were prevalent symptoms of developmental disturbances in the sample of prematures. Alterations at neurological examination did not discriminate between the two groups, although cerebral palsy occurred only in the proup of prematures. The ENE functions which differentiated the two groups studied were dynamic balance, appendicular and trunk-limb coordination and motor persistence.KEY WORDS: prematurely born children, development, evolutional neurologic evaluation. Avaliação neurológica evolutiva aos sete anos de idade de crianças nascidas prematurasRESUMO -Para estudar o desenvolvimento neuropsicomotor em amostra de prematuros aos 7 anos de idade, foram avaliadas 51 crianças prematuras e comparadas com 44 a termo. O grupo de prematuros tinha idade gestacional de até 37 semanas e 6 dias e peso de nascimento até 2500g. O grupo controle foi constituído de crianças com idade gestacional entre 38 e 42 semanas e acima de 2500g. Os instrumentos de avaliação utilizados foram os exames clinico, neurológico e neurológico evolutivo (ENE). Os resultados mostraram que impulsividade, agressividade, desorganização e enurese foram sintomas prevalentes nos prematuros. As alterações no exame neurológico não discriminaram os grupos, embora paralisia cerebral só tenha ocorrido nos prematuros. As funções do ENE que distinguiram os grupos foram equilíbrio dinâmico, coordenação tronco-membros e persistência motora, constituindo-se esta no comprometimento dominante nos prematuros e as alterações na coordenação tronco-membros em achado peculiar neste grupo. PALAVRAS-CHAVE: prematuridade, desenvolvimento neuropsicomotor, exame neurológico evolutivo.It has been well established that the development of the central nervous system (CNS) begins at conception and continues to adulthood. Psychomotor development has also been observed during intrauterine life 22 . CNS development is achieved through a series of transformations. An early phase of neuronal proliferation that occurs between the second and fourth month of gestation involves neurons and glial cells derived from the ventricular and sub-ventricular zones. During a second phase of neuronal migration, between the third and fifth month of gestation, millions of neurons move from their original site to their final locations. A third phase involves the organization that begins around the sixth month of gestation and persists for several years. Lastly, the final phase of neuronal maturation is related to the myeli...