Machine Learning-Based Clinical Adjusted Selection of Predicting Risk Factors for Shunt Infection in Children

   Background: Shunt Infection is a common complication of shunt insertion in children which can lead to bad neuro-developmental conditions and impose a considerable economic burden for the health care system. So, identifying predictive factors of shunt infection could help us in the proper improvement of this deteriorating condition. Methods: In this study, related risk factors of 68 patients with history of shunt infection and 80 matched controls without any history of shunt infection, who were all operated in a single referral hospital were assessed. Three machine learning (ML)-based measures including sparsity, correlation, and redundancy along with specialist’s score were applied to select the most important predictive risk factors for shunt infection. ML was determined by summation of sparsity, correlation and redundancy measures, and the final total score was considered as normalization (ML-based score + specialist score). Results: According to the total score, prematurity, first ventriculoperitoneal shunting (VPS) age, intraventricular hemorrhage (IVH), myelomeningocele (MMC) and low birth weight had higher weights as shunt infection risk factors. icterus, trauma, co-infection and tumor had the lowest weights and history of meningitis and number of shunt revisions were defined as intermediate risk factors. Conclusion: The “ML-based clinical adjusted” method may be used as a complementary tool to help neurosurgeons in better patient selection and more accurate follow-up of children with higher risk of shunt infection

Brain abscess as a manifestation of spinal dermal sinus

Dermal sinuses have been associated with a wide spectrum of clinical manifestations ranging from asymptomatic to drainage of purulent material from the sinus tract, inclusion tumors, meningitis, and spinal abscess. To date, there has been no documented report of brain abscess as a complication of spinal dermal sinus. Here, we report an 8-month-old girl who was presented initially with a brain abscess at early infancy but lumbar dermal sinus and associated spinal abscess were discovered afterwards. The probable mechanisms of this rare association have been discussed

Double dermal sinuses: a case study

<p>Abstract</p> <p>Introduction</p> <p>Dermal sinus tracts are rare congenital lesions located in the midline characterized by a cutaneous pit or dimple. They occur all along the midline neuroaxis, from the nasion and occipital area down to the lumbar and sacral regions, most frequently in the lumbar and lumbosacral region.</p> <p>Case presentation</p> <p>Here we report a 5-year-old girl who presented with occasional headache. There were two dimples, one on the dorsal aspect of her head and another on her neck.</p> <p>Conclusion</p> <p>Dermal sinuses are almost always singular and the co-existence of double dermal sinuses has not been reported previously.</p

Congenital spinal tumor in a patient with encephalocele and hydrocephalus: a case report

<p>Abstract</p> <p>Introduction</p> <p>Encephalocele is a rare congenital abnormality of the central nervous system, where brain tissue protrudes from a defect in the skull. Some anomalies are associated with encephalocele. However, the association of spinal teratoma and encephalocele has not been reported in the English literature.</p> <p>Case presentation</p> <p>We report the case of an Iranian girl with a history of encephalocele surgery, who, at the age of four years, developed an intramedullary spinal teratoma, and discuss the pathogenesis of this association.</p> <p>Conclusion</p> <p>To the best of our knowledge, this is the first report of an association between encephalocele and spinal teratoma.</p

The prenatal ultrasonographic detection of myelomeningocele in patients referred to Children's Hospital Medical Center: a cross sectional study

BACKGROUND: To find out about the prenatal diagnosis rate of myelomeningocele (MMC) by ultrasound scan in patients referred to the Children's Hospital Medical Center in Tehran, Iran from July 2004 to July 2005. METHODS: We included 140 children born with MMC and who were referred for management, surgery and treatment of complications associated with it. The ultrasound reports were examined. Data on sex, age, location of MMC, time of prenatal ultrasound and the trimester in which the diagnosis was made along with the results of the diagnosis (MMC, hydrocephalus, or both), were collected. RESULTS: Among the studied patients, 136 (97.1%) cases had prenatal ultrasound, amongst those, 58 (42.6%) sonographic evaluations were diagnostic for hydrocephalus and/or MMC. The prenatal ultrasound was positive for MMC in 16 (11.8%), hydrocephalus in 25 (18.4%) and both MMC and hydrocephalus in 17 (12.5%) cases. Among all cases with prenatal diagnosis of MMC, 3.4% were detected in the first, 31% in the second and 65.5% in the third trimester. Thoracic/thoracolumbar lesions were found prenatally in 40% of cases, which is significantly higher than the detection rate of other locations including cervical/cervicothoracic and lumbar/lumbosacral/sacral regions diagnosed only in 0% and 21% of cases respectively. CONCLUSION: There is a large difference between the detection rate of our population (24.3%) compared to others (68%). Pregnant women should have an ultrasound at 20–22 week for detection of congenital anomalies including MMC

Acquired craniomeningocele in an infant with craniosynostosis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Craniosynostosis can affect the skull in various ways. The most common forms are abnormal skull shape and beaten copper pattern, while Lückenschädel (or lacunar skull) is one of the least common forms.</p> <p>Case presentation</p> <p>We report the case of a 3-month-old Caucasian boy with multiple suture craniosynostosis and with acquired craniomeningocele presenting as a bulging mass in the lateral occipital area.</p> <p>Conclusion</p> <p>To the best of our knowledge, this is the first report of a patient with multiple suture craniosynostosis and acquired craniomeningocele.</p

Sudden deterioration due to intra-tumoral hemorrhage of ependymoma of the fourth ventricle in a child during a flight: a case report

<p>Abstract</p> <p>Introduction</p> <p>To the best of our knowledge, the association between air travel and intra-tumoral hemorrhage in pediatric populations has never been described previously.</p> <p>Case presentation</p> <p>We report the case of a two-and-a-half-year-old Caucasian, Iranian boy with a hemorrhaging brain tumor. He had a posterior fossa midline mass and severe hydrocephalus. He had been shunted for hydrocephalus four weeks earlier and was subsequently referred to our center for further treatment. The hemorrhage occurred in an infra-tentorial ependymoma, precipitated by an approximately 700-mile air journey at a maximum altitude of 25,000 feet.</p> <p>Conclusions</p> <p>A pre-existing intra-cranial mass lesion diminishes the ability of the brain to accommodate the mild environmental disturbances caused by hypercarbia, increased venous pressure and reduced cerebral blood flow during long air journeys. This is supported by a literature review, based on our current knowledge of physiological changes during air travel.</p

Prophylactic antibiotic for prevention of posttraumatic meningitis after traumatic pneumocephalus: design and rationale of a placebo-controlled randomized multicenter trial [ISRCTN71132784]

BACKGROUND: The purpose of this study is to compare the efficacy of prophylactic antibiotic for prevention of meningitis in acute traumatic pneumocephalus patients. METHODS: In this prospective, randomized controlled clinical trial, 200 selected head injury patients with traumatic pneumocephalus are randomly assigned to receive intravenous antibiotics (2 grams Ceftriaxone twice a day), oral antibiotics (Azithromycin) or placebo for at least 7 days after trauma. The patients will be followed for one month posttrauma. CONCLUSION: The authors hope that this study helps clarifying the effectiveness and indications of antibiotics in prevention of meningitis in traumatic pneumocephalus after head injury and in specific subgroup of these patients