The purpose of this study was to test the hypothesis that children with developmental delay without regression of unknown etiology are more likely to have intracranial incidental findings than are children with autistic spectrum disorder or children with normal development. Of 771 patients with magnetic resonance images, 363 (47.1%) patients had developmental delay, 55 (7.1%) had autistic spectrum disorders, and 353 (45.8%) were developmentally normal. Developmentally delayed children were more likely than those with normal development (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.3-2.5; P < .001) or those with autistic spectrum disorder (OR, 2.1; 95% CI, 1.1-4.1; P = .019) to have an intracranial incidental finding. We report a higher prevalence of intracranial incidental findings in children with developmental delay as compared with those children with normal development. Future study should confirm whether the result of this study is merely incidental or truly related to a subgroup of children with developmental disability.

Intracranial incidental findings on magnetic resonance imaging (MRI) of the brain continue to generate interest in healthy control, research, and clinical subjects. However, in clinical practice, the discovery of incidental findings acts as a "distractor". This review is based on existing heterogeneous reports, their clinical implications, and how the results of incidental findings influence clinical management. This draws attention to the followings: (1) the prevalence of clinically significant incidental findings is low; (2) there is a lack of a systematic approach to classification; and discusses (3) how to deal with the detected incidental findings based a proposed common clinical profile. Individualized neurological care requires an active discussion regarding the need for neuroimaging. Clinical significance of incidental findings should be decided based on lesion's neuroradiologic characteristics in the given clinical context. Available evidence suggests that the outcome of an incidentally found "serious lesion in children" is excellent. Future studies of intracranial incidental findings on pediatric brain MRI should be focused on a homogeneous population. The study should address this clinical knowledge based review powered by the statistical analyses.

Prodrome and aura constitute preictal symptomatology of migraines. The objective of this clinical review is to examine the diagnostic and therapeutic significance of preictal symptomatology in children with migraines. The systemic review of the literature identified a single study in children with migraines. The majority studies were in adults. Based on our search and longitudinal clinical observation, we describe the clinical characteristics of diagnostic and therapeutic significance of preictal symptoms and various types of auras in migraines. Such significance can be substantially increased by including prodromal physical signs in children with migraines. Future studies' methodology should include physical signs in addition to symptoms and identify the spectrum of the various auras, and relate to their temporal association with ictal and postictal phases of migraines. In addition these clinical parameters should be statistically analyzed.

No abstract

Acute polyneuropathy in children with acute lymphoblastic leukemia is extremely rare, but its onset and association with Guillain-Barré syndrome presents a diagnostic challenge. We report a 5-year-old boy who presented with inability to walk during induction chemotherapy for acute lymphoblastic leukemia. Subsequently he developed painful penile erections, difficulty urinating and swallowing. Besides adding a rare case to the literature and based on a systemic review of the literature, we provide and discuss the neurologic profile and differential diagnosis of the acute polyneuropathy in childhood leukemia. Early recognition of acute polyneuropathy in children with acute lymphocytic leukemia will facilitate a judicious use of immunotherapy for Guillain-Barré syndrome and prevent a high morbidly and mortality.

Gilles de la Tourette's syndrome is an uncommon illness associated with repetitive un-voluntary abnormal movements and utterance. It is often associated with other psychiatric morbidities. Management requires awareness of this uncommon illness, keen observation, relevant evaluation, and combination of pharmacology and psychotherapy for an optimal outcome. This case is brought out here for florid presentation and nuances of management.

rapid and severe when drug administration is suspended and re-challenged. NVP induced rash has been reported in 4.3-36% of adults [3] with prevalence for Thai HIV patients ranging from 6% to -21%. [4] In Sardinian population were HLA B14 and Cw8 was associated 26% developed NVP induced rash, in our study from India we found that NVP-induced rash was 2.14%, thus, refl ecting the comparatively a high incidence of drug-related rash in Asians. [5] Recent studies have shown that hypersensitivity reactions to antiretroviral drugs are HLAassociated. HIV-infected Thai patients have a signifi cant HLA Cw*04 allele association with nevirapine induced rash cases. [4] HLA B*3505 allele has been identifi ed as a strong predictor for nevirapine-induced skin adverse reactions in Thai HIV patients. [6] This study shows that HLA B35 is signifi cantly associated among the nevirapine-induced skin rash HIV-1 ARV-treated patients of India. Further, the molecular HLA characterization of these alleles will enlighten us on the immunological basis of the antiretroviral drug reactions.

We report a rare case of angioedema in an adolescent female with multiple problems, seizures migraines, peudotumor cerebrii, supraventricular tachycardia, and obesity. Management of drug therapy in such patients presents a clinical challenge. We discuss a single drug solution particularly in those patients in whom the memory of side effects of the drug is a vivid reality.