Psödotümör Serebri Kliniği İle Gelen Spinal Kitle Olgusu

Medulla spinalis tümörleri, kafa içi basınç artış sendromunun nadir nedenleri arasındadır ve kafa içi basınç artışı spinal tümörlü hastalarda nadiren görülmektedir. Hastamız olan erkek çocuk, baş ağrısı şikâyetiyle başvurmuş ve hastamıza papil ödemi bulgularıyla psödotümör serebri ön tanısı konulmuştur. Ancak hastanın beyin omurilik sıvısında protein artışının saptanması üzerine çekilen spinal manyetik rezonans görüntüleme ile spinal tümör (grade 4 medulloblastom) tanısı konmuştur. Bu olgu ile artmış intrakranial basınç bulguları ile başvuran ve nörolojik defisiti olmayan hasta grubunda da medulla spinaliste kitle tespit edilebileceğine dikkat çekmek istedik.Anahtar kelimeler: baş ağrısı, psödotümör serebri, spinal kitl

Characteristics of pediatric multiple sclerosis: The Turkish pediatric multiple sclerosis database

Objective To document the clinical and paraclinical features of pediatric multiple sclerosis (MS) in Turkey. Methods Data of MS patients with onset before age 18 years (n = 193) were collected from 27 pediatric neurology centers throughout Turkey. Earlier-onset (<12 years) and later-onset (?12 years) groups were compared. Results There were 123 (63.7%) girls and 70 (36.3%) boys aged 4–17 years, median 14 years at disease onset. Family history of MS was 6.5%. The first presentation was polysymptomatic in 55.4% of patients, with brainstem syndromes (50.3%), sensory disturbances (44%), motor symptoms (33.2%), and optic neuritis (26.4%) as common initial manifestations. Nineteen children had facial paralysis and 10 had epileptic seizures at first attack; 21 (11%) were initially diagnosed with acute disseminated encephalomyelitis (ADEM). Oligoclonal bands were identified in 68% of patients. Magnetic resonance imaging revealed periventricular (96%), cortical/juxtacortical (64.2%), brainstem (63%), cerebellum (51.4%), and spinal cord (67%) involvement. Visual evoked potentials (VEP) were abnormal in 52%; serum 25-hydroxyvitamin D levels were low in 68.5% of patients. The earlier-onset group had a higher rate of infection/vaccination preceding initial attack, initial diagnosis of ADEM, longer interval between first 2 attacks, and more disability accumulating in the first 3 years of the disease. Conclusion Brainstem and cerebellum are common sites of clinical and radiological involvement in pediatric-onset MS. VEP abnormalities are frequent even in patients without history of optic neuropathy. Vitamin D status does not appear to affect the course in early disease. MS beginning before 12 years of age has certain characteristics in history and course