Six boys and five girls with a mean age of 8.6 (range 3 to 13) years with foetal alcohol syndrome (FAS) were studied by MRI and single photon emission computed tomography (SPECT) to find specific areas of vulnerability. Morphological anomalies shown in six of 11 patients by MRI were situated both cortically and subcortically: cortical atrophy (N = 2), dilated ventricle (N = 1), corpus callosum hypoplasia (N = 1), cerebellar atrophy (N = 2), one of the latter with Arnold-Chiari malformation (N = 1). Delayed myelination of the white matter was seen in two patients. Volumetric studies of the hippocampus showed morphological left-right asymmetry in five of eight patients. However, SPECT showed mild hypoperfusion of the left hemisphere in all 10 subjects. The negative left-right index was located especially in the left parietooccipital region, i.e. in the brain areas implicated in arithmetical and logical-grammatical functions, which are known to be affected in FAS. Normal left-right dominance was also lacking in the frontal area, i.e. the brain area affected in attention-deficit-hyperactivity disorder (ADHD). Detection of these abnormalities, although they are not unique to FAS, may be helpful in the diagnosis and any attempts at rehabilitation. Diverse morphological and functional abnormalities are more frequent than has usually been believed even in less impaired children with FAS.
Six boys and five girls with a mean age of 8.6 (range 3 to 13) years with foetal alcohol syndrome (FAS) were studied by MRI and single photon emission computed tomography (SPECT) to find specific areas of vulnerability. Morphological anomalies shown in six of 11 patients by MRI were situated both cortically and subcortically: cortical atrophy (N=2), dilated ventricle (N=1), corpus callosum hypoplasia (N=1), cerebellar atrophy (N=2), one of the latter with Arnold‐Chiari malformation (N=1). Delayed myelination of the white matter was seen in two patients. Volumetric studies of the hippocampus showed morphological left‐right asymmetry in five of eight patients. However, SPECT showed mild hypoperfusion of the left hemisphere in all 10 subjects. The negative left‐right index was located especially in the left parietooccipital region, i.e. in the brain areas implicated in arithmetical and logical‐grammatical functions, which are known to be affected in FAS. Normal left‐right dominance was also lacking in the frontal area, i.e. the brain area affected in attention‐deficit‐hyperactivity disorder (ADHD). Detection of these abnormalities, although they are not unique to FAS, may be helpful in the diagnosis and any attempts at rehabilitation. Diverse morphological and functional abnormalities are more frequent than has usually been believed even in less impaired children with FAS.
Mild abnormal findings in brain perfusion, the EEG and in cognitive processing are common in children with type 1 diabetes, but these abnormalities are not associated with previous severe hypoglycaemia.We studied the effect of diabetes on long-term brain function by comparing two age-matched groups of normally developed prepubertal type 1 diabetes children (age 5.6-11.9 years, diabetes duration 1.8-9.6 years). Of the 20 patients, 10 had experienced severe hypoglycaemia leading to unconsciousness and/or convulsions. All patients were in normal school or preschool. Their mean HbA1c ± SD was 8.4±1.7% (reference range 4.0%-6.2%). For every patient, we performed within 1 month (1) cerebral blood flow detected by single-photon emission tomography (SPECT) without anaesthesia, (2) brain electrical activity detected by 8-channel EEG, and (3) cognitive function evaluated by comprehensive neuropsychological assessment. The blood glucose level of the patients was measured before each study session to avoid hypoglycaemia.In the SPECT analysis, transaxial slices were reconstructed at three levels: canto-meatal line (CM) +36 mm, 48 mm, and 64 mm. Six symmetrical cortical regions of interest (ROI) were drawn on each hemisphere and labelled from the frontal to the occipital as ROIs 1 to 6 [3]. The average radioactivity of each region and hemisphere was measured and the left-right index was calculated for each ROI and hemisphere (2 · (left-right)/(left + right)), where left and right represent the average radioactivities of two symmetrical ROIs in each hemisphere. Data from the literature were used for normal cerebral blood flow [1]. EEGs were analysed visually and semiquantitatively and scored 0-5 according to amount of background slowing, paroxysmality, and focal abnormalities.Intelligence was assessed with The Wechsler Intelligence Scale for Children-Revised (WISC-R) [4] or Wechsler Preschool and Primary Scale of IntelligenceRevised (WPPSI-R) [5]. Cognitive functions were evaluated with The Developmental Neuropsychological Assessment (NEPSY) [2] in five domains (Table 1). Of the 30 NEPSY tests, 16 were administered.The left-right indexes in SPECT were tested both between the groups and against zero with the Student t-test. According to power-analysis, the number of subjects in each group was sufficient to detect a difference of 0.05 in the left-right index. Fisher's exact test was used for comparison of EEGs. The Student t-test and the v 2 test were used to determine group differences in the neuropsychological study. P values <0.05 were considered significant.The left-right index of the hemispheres in both groups was negative. These results differ from those of normal children, in whom the left cerebral blood flow values are significantly higher than the right values [1]. The left-right index of the hemispheres of the two groups did not differ from each other. However, the hypoglycaemic patients had significantly more ROIs where the left-right index exceeded the average +2SD than did the other patients (9 versus 2, the number o...
McCune-Albright syndrome should be considered in the differential diagnosis when interpreting extensive unilateral predominance in paediatric bone scans.
SummaryA new method for the quantitative determination of the radioactivity in the lungs utilizing external counting has been described. The method is based on a quick and almost complete retention in the lungs of another radioactivity labelled substance (macroaggregated 131I human serum albumin) after an intravenous injection, a fact which gives an excellent calibration of detector efficiency when the same isotope (131I) is employed.The method decribed has been applied especially to the determination of amounts of a radiological contrast material (Lipiodol) getting into the lungs in connection with a routine lymphography with the radioactive tracer method. The maximum amount of Lipiodol in the lungs was found at 24-48 hours after the lymphography, the accumulation in the lungs being 20-60% of the injected volume of Lipiodol (5 patients) and an average biological half life being 8.8 days.
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