Hemiparetic Cerebral Palsy: Etiological Risk Factors And Neuroimaging

The purpose of this paper, which was conducted on 175 children with hemiparetic cerebral palsy (H-CP), was to verify the etiological risk period for this disease. Etiological risk factors (ERF) were detected through anamnesis: 23% in the prenatal period, 18% in the perinatal period and 59% of the patients the period was undefined (ERF in the prenatal and perinatal period was 41% and no ERF was 18% of the cases. The computerized tomographic scan (CT) and MRI were performed on all the patients, who were then classified according to their etiopathogenic data: CT1 = normal (18%); CT 2= unilateral ventricular enlargement (25%); CT 3 = cortical/ subcortical cavities (28%); CT4= hemispheric atrophy and other findings (14%); CT 5 = malformations (15%). CT 5 was associated with physical malformations beyond the central nervous system and with prenatal ERF's , while CT 2 was associated with the perinatal ERF's, mainly in premature births. Magnetic resonance imaging was performed on 57 patients and demonstrated a good degree of concordance with the CT. Etiology remained undefined in only 37% of the cases after neuroimaging was related to ERF. A high perinatal RF frequency (59%) was observed and emphasized the need for special care during this period.5912934Kuban, K.C.K., Leviton, A., Cerebral palsy (1994) N Engl J Med, 330, pp. 188-195Griffiths, M., Clegg, M., (1988) Cerebral Palsy: Problems and Practice, , London: Souvenir PressUvebrant, P., Hemiplegic cerebral palsy: Aetiology and outcome (1988) Acta Paediatr Scand, (345 SUPPL.), pp. 1-100Nelson, K.B., Ellenberg, J.H., Antecedents of cerebral palsy: Multivariate analysis of risk (1986) N Engl J Med, 315, pp. 81-86Blair, E., Stanley, F.J., Intrapartum asphyxia: A rare cause of cerebral palsy (1988) J Pediatr, 112, pp. 515-519Barkovich, A.J., Destructive brain disorders of childhood (1995) Pediatric Neuroimaging. 2.ed., pp. 107-175. , Barkovich AJ. New York: Raven PressBarkovich, A.J., Congenital malformations of the brain (1995) Pediatric Neuroimaging. 2.ed., pp. 176-275. , Barkovich AJ. New York: Raven PressOkumura, A., Hayakawa, F., Katu, T., Kuno, K., Watanabe, K., MRI findings in patients with spastic cerebral palsy: I. Correlation with gestational age at birth (1997) Dev Med Child Neurol, 39, pp. 363-368Hagberg, B., Hagberg, G., Olow, I., Von Wendt, L., The changing panorama of cerebral palsy in Sweden: VII. Prevalence and origin in the birth year period 1987-90 (1996) Acta Paediatr Scand, 85, pp. 954-960Leviton, A., Paneth, N., White matter damage in preterms newbornsl an epidemiological perspective (1990) Early Hum Dev, 24, pp. 1-22Wiklund, L.M., Uvebrant, P., Hemiplegic cerebral palsy: Correlation between CT morphologic and clinical findings (1991) Dev Med Child Neurol, 33, pp. 512-523Niemann, G., Wakat, J.P., Krägeloh-Mann, I., Grodd, W., Michaelis, R., Congenital hemiparesis and perventricular leukomalacia: athogenic aspects on magnetic resonance imaging (1994) Dev Med Child Neurol, 36, pp. 943-950Rogers, B., Msall, M., Owens, T., Cystic periventricular leukomalacia and type of cerebral palsy in preterm infants (1994) J Pediatr, 125, pp. S1-S8Volpe, J.J., Intracranial hemorrhage: Intraventricular hemorrhage of the premature infant (1995) Neurology of the Newborn. 3.ed., pp. 403-463. , Volpe JJ. Philadelphia: SaundersOkumura, A., Hayakawa, F., Katu, T., Kuno, K., Watanabe, K., MRI findings in patients with spastic cerebral palsy: II. Correlation with type of cerebral palsy (1997) Dev Med Child Neurol, 39, pp. 369-372Bouza, H., Dubowitz, L.M.Z., Rutherford, M., Cowan, F., Pennock, J.M., Late magnetic resonance imaging and clinical finding in neonates with unilateral lesions on cranial ultrasound (1994) Dev Med Child Neurol, 36, pp. 951-954Wiklund, L.M., Uvebrant, U., Flodmark, O., Morphology of cerebral lesions in children with congenital hemiplegia: A study with computed tomography (1990) Neuroradiology, 32, pp. 179-186Moura-Ribeiro, M.V.L., Ciasca, S.M., Vale-Cavalcanti, M., Etchebehere, E.C.S.C., Camargo, E.E., Cerebrovascular disease in newborn infants: Report of three cases with clinical follow-up and brain SPECT cerebral (1999) Arq Neuropsquiatr, 57, pp. 1005-1010Molteni, B., Oleari, G., Fedrizzi, E., Bracchi, M., Relation between CT patterns, clinical findings and etiological factors in children born at term, affected congenital hemiparesis (1987) Neropediatrics, 18, pp. 75-80Piovesana, A.M.S.G., (1993) Paralisia Cerebral Hemiparética: Estudo de 42 Casos, , Dissertação de Mestrado, Faculdade de Ciências Médicas da Universidade Estadual de Campinas. CampinasPiovesana, A.M.S.G., (1999) Paralisia Cerebral Hemiparética: Aspectos Evolutivos, Plasticidade Cerebral e Especialização Hemisférica, , Tese de Doutorado, Faculdade de Ciências Médicas da Universidade Estadual de Campinas. CampinasFleiss, J.L., (1981) Statistical Methods for Rates and Proportions. 2,ed., , New York: John Wiley & SonsStokes, M.E., Davis, C.S., Koch, G.G., (1996) Categorical Data Analysis Using the SAS System, , Cary NC: SAS InstituteHagberg, B., Hagberg, G., Olow, I., The changing panorama of cerebral palsy in sweden: IV. Epidemiological trends 1959-78 (1984) Acta Paediatr Scand, 73, pp. 433-440Christensen, E., Melchior, J., Cerebral palsy: A clinical and neuropathological study (1967) Clin Dev Med, 25, pp. 55-67. , London: HeinemannBanker, B.Q., Larroche, J.-C., Periventricular leukomalacia of infancy: A form of neonatal anoxic encephalopathy (1962) Arch Neurol, 7, pp. 386-41

Diskitis in children: study of eight cases

The authors report the study of eight children with diskitis diagnosed through clinical, neurogical and orthopedic evaluation. The evidence of self limiting inflammation or infection of the intervertebral disk space and of soft tissue were avaliable by image studies. Findings with routine roentgenograms, computed tomography and magnetic resonance imaging are discussed.Os autores apresentam o estudo de oito crianças com diagnóstico de discite estabelecido através da avaliação clínica, neurológica e ortopédica. A comprovação de alterações inflamatórias em um espaço discal, vertebral e em tecidos moles foi possível em estudos por imagem, sendo discutidos aqueles obtidos por radiologia convencional, tomografia computadorizada e ressonância magnética.53553

Neuropsychomotor Development Of Infants Born Of Mothers With Gestational Hypertension [desenvolvimento Neuropsicomotor De Lactentes Filhos De Mães Que Apresentaram Hipertensão Arterial Na Gestação]

Introduction: Gestational hypertension is a major cause of maternal death in our country and may be associated with neonatal hypoxic-ischemic encephalopathy with serious neurological complications. Objective: To correlate gestational hypertension with risk factors of neuropsychomotor development in infants. Method: This was a prospective study. We evaluated 30 consecutive infants born of mothers with gestational hypertension. The following risk factors were considered: small for gestational age; fetal asphyxia; age of onset of gestational hypertension; term/preterm newborn; Apgar scores; central cyanosis; O2 mask; meconium. The study followed two steps. In the first step, newborns underwent neurological examination soon after birth (48-72 hours of life). In the second step, children underwent another neurological assessment between 7 and 15 months of life. Results: Six newborns presented neurological signs on the first evaluation. The only risk factor that showed a significant correlation with the neurologic examination was the Apgar score. Other risk factors did not show any correlation. All children evaluated on the second step of the study showed normal neurological development and examination, which did not allow any correlation with risk factors. Conclusion: Our data suggest that gestational hypertension per se is not sufficient to cause fetal neurological impairment.633 A632636Resende, J., Doença hipertensiva específica da gestação: Pré-eclâmpsia e eclâmpsia (1995) Obstetrícia, 22, pp. 598-642Impey, L., Greenwood, C., Sheil, O., MacQuillan, K., Reynolds, M., Redman, C., The relation between pre-eclampsia at term and neonatal encephalopahty (2001) Arch Dis Child, 85, pp. 170-172Rufo, M.C., Palencia, R.L., Encefalopatia hipóxico-isquémica del recién nacido a término: Recientes avances, marcadores de hipoxia y opciones terapéuticas (2000) Rev Neurol, 31, pp. 617-623Marques-Dias, M.J., Encefalopatias hipóxico-isquêmicas e hemorragias intracranianas (1999) Neurologia Infanhl, pp. 667-674. , Diament A, Cypel S (eds). São Paulo: Livraria AtheneuDiament, A., Exame neurológico do recém-nascido de termo (1999) Neurologia Infantil, pp. 10-21. , Diament A, Cypel S (eds). São Paulo: Livraria AtheneuVolpe, J.J., Hipoxic-isquemic encephalopathy: Neuropathology and pathogenesis (2001) Neurology of the Newborn, 4th Edition, pp. 296-330. , Volpe JJ (ed). Philadelphia: W.B. SaundersKeeling, J.W., Acquired diseases of the nervous system (1993) Fetal Neonatal Pathology, 24, pp. 571-593Gherpelli, J.L., Avaliação neurológica do recém-nascido prematuro (1999) Neurologia Infantil, pp. 22-32. , Diament A, Cypel S (eds). São Paulo: Livraria AtheneuDiament, A., Exame neurológico do lactente (1999) Neurologia Infantil, pp. 33-61. , Diament A, Cypel S (Eds). São Paulo: Livraria AtheneuFrankenburg, W.K., Denver developmental screening (1967) J Fed, 71, pp. 181-191Volpe, J.J., Hypoxic-ischemic encephalopathy: Intrauterine assessment (2001) Neurology of the Newborn. 4th Edition, pp. 277-295. , Volpe JJ (Ed). Philadelphia: W.B. Saunders CompanyVolpe, J.J., Hypoxic-ischemic encephalopathy: Clinical aspects (2001) Neurology of the Newborn, 4th Edition, pp. 331-394. , Volpe JJ (ed). Philadelphia: W.B. SaundersMutch, L.M., Moar, V.A., Ounsted, M.K., Redman, C.W., Hypertension during pregnancy, with and without specific hypotensive treatment: I. Perinatal factors and neonatal morbidity (1977) Early Hum Dev, 1, pp. 47-57Spinillo, A., Stronati, M., Ometto, A., Fazzi, E., Lanzi, G., Guaschino, S., Infant neurodevelopmental outcome in pregnancies complicated by gestational hypertension and intra-uterine growth retardation (1993) J Perinat Med, 21, pp. 195-203Gonzalez De Dios, J., Moya, M., Perinatal asphyxia, hypoxic-ischemic encephalopahty and neurological sequelae in full-term newborns: II. Description and interrelation (1996) Rev Neurol, 24, pp. 969-976Moster, D., Lie, R.T., Markestad, T., Joint association of Apgar socres and early neuonatal symptoms with minor disabilities at school age (2002) Arch Dis Child Fetal Neonatal, 86, pp. 16-21Gross, S.J., Kosmetatos, N., Grimes, C.T., Williams, M.L., Newborn head size and neurological status: Predictors of growth and development of low birth weight infants (1978) Am J Dis Child, 132, pp. 753-756Skouteli, H.N., Dubowitz, L.M., Levene, M.I., Miller, G., Predictors for survival and normal neurodevelopmental outcome of infants weighing less than 1001 grams at birth (1985) Dev Med Child Neurol, 27, pp. 588-595Ruth, V.J., Raivio, K.O., Perinatal brain damage: Predictive value of metabolic acidosis and the Apgar score (1988) BMJ, 297, pp. 24-27Marlow, N., Do we need an Apgar score? (1992) Arch Dis Child, 67, pp. 765-767Silverman, F., Suidan, J., Wasserman, J., The Apgar score: Is it enough? (1985) Obstet Gynecol, 66, pp. 331-336Marrin, M., Paes, B.A., Birth asphyxia: Does the Apgar score have diagnostic value? (1988) Obstet Gynecol, 72, pp. 120-12

Clinical And Videofluoroscopic Evaluation Of Swallowing In Patients With Spastic Tetraparetic Cerebral Palsy And Athetosic Cerebral Palsy [evaluación Clínica Y Videofluoroscópica De La Deglución En Pacientes Con Parálisis Cerebral Tetraparésica Espástica Y Atetósica]

Aim. To evaluate and to compare the findings of oral and pharyngeal phases of swallowing in children with both spastic tetraparetic cerebral palsy (STCP) and with athetosic cerebral palsy (ACP). Patients and methods. 11 children were evaluated, with their ages ranging from 10 months to 8 years old, through both clinical assessment and videofluoroscopic evaluation. Results. The children with STCP were more involved at the neurologic, clinical and speech-language and hearing aspects. At the oral phases all the children had presented some involvement. At the pharyngeal phases the clinical signs of aspiration were identified in 10 children. It was observed aspirations in 80% of children with STCP and in 67% with ACP. The changes on swallowing were similar in both cerebral palsy groups, but the performance of the children with STCP was inferior. Conclusion. The videofluoroscopy was an important method which makes possible the verification of aspirations, helping the professionals at the therapeutical program for these children. © 2006, Revista de Neurología.428462465Chen, M.Y.M., Peele, V.N., Donati, D., Ott, D.J., Donofrio, P.D., Gelfand, D.W., Clinical and fluoroscopic evaluation of swallowing in 41 patients with neurologic disease (1992) Gastrointest Radiol, 17, pp. 95-98Logemann, J.A., Swallowing physiology and pathophysiology (1988) Otolaryngol Clin North Am, 21, pp. 613-623Furkim, A.M., (1999) Deglutição de crianças com paralisia cerebral do tipo tetraparética espástica: Avaliação clínica fonoaudiológica e análise videofluoroscó pica, , São Paulo: Universidade Federal de São Paulo;Furkim AM, Silva RG. Conceitos e implicações para a prática clínica e para a classificação da disfagia orofaríngea neurogênica. In Furkim AM, Silva RG. Programas de reabilitação em disfagia neurogênica. São Paulo: Frôntis1999. p. 1-20Logemann, J.A., (1983) Evaluation and treatment of disorders, , San Diego: College Hill;Pino-Quera R, Caffri-Defilippi C. Disfagia orofaríngea. Acta Gastroenterol Latinoam 200112: 26-35Perlman, A.L., Lu, C., Jones, B., Radiographic contrast examination of the mouth, pharynx and esophagus (1997) Deglutition and its disorders: Anatomy, phisiology, clinical diagnosis, and management, pp. 153-199. , Perlman AL, Schulze-Delrieu K, eds, San Diego: Singular;Rogers, B., Arvedson, J., Buck, G., Smart, P., Msall, M., Characteristics of dysphagia in children with cerebral palsy (1994) Dysphagia, 9, pp. 69-73Grunert-Paolinelli, P., Bontes-Lukoviek, A., Videofluoroscopía VFC em el estúdio de los transtornos de la deglución (2000) Revista Chilena de Radiología, 6, pp. 5-7Furkim, A.M., Behlau, M.S., Weckx, L.L.M., Avaliação clínica e videofluoroscópica da deglutição em crianças com paralisia cerebral tetraparética espástica (2003) Arq Neuropsiquiatr, 61, pp. 611-616Kramer, S.S., Eicher, P.S., Swallowing in children (2003) Normal and abnormal swallowing: Imaging in diagnosis and therapy, pp. 205-226. , Jones B, ed, 2 ed. New York: Springer;Morton, R.E., Bonas, R., Fourie, B., Minford, J., Videofluoroscopy in the assessment of feeding disorders of children with neurological problems (1993) Dev Med Child Neurol, 35, pp. 388-395Helfrich-Miller, K.R., Rector, K.L., Straka, J.A., Dysphagia: Its treatment in the profoundly retarded pacient with cerebral palsy (1986) Arch Phys Med Rehabil, 67, pp. 520-525Plant, R.L., Anatomy and physiology of swallowing in adults and geriatrics (1998) Otolaryngol Clin North Am, 31, pp. 477-488Griggs, C.A., Jones, P.M., Lee, R.E., Videofluoroscopic investigation of feeding disorders of children with multiple handicap (1989) Dev Med Child Neurol, 31, pp. 303-308Buchholz, D.W., Neurogenic dysphagia: What is the cause when the cause is not obvious? (1994) Dysphagia, 9, pp. 245-255Arvedson, J., Rogers, B., Buck, G., Smart, P., Msall, M., Silent aspiration prominent in children with dysphagia (1994) Int J Pediatr Otorhinolaryngol, 28, pp. 173-181Dantas, R.O., Kern, M.K., Massey, B.T., Dodds, W.J., Kahrilas, P.J., Brasseur, J.G., Effect of swallowed bolus variables on oral and pharyngeal phases of swallowing (1990) Am J Physiol, 258, pp. 675-681Lazarus, C.L., Logemann, J.A., Rademaker, A.W., Kahrilas, P.J., Pajak, T., Lazar, R., Effects of bolus volume, viscosity, and repeated swallows in nonstroke subjects and stroke patients (1993) Arch Phys Med Rehabil, 74, pp. 1066-1070Costa, M.M.B., Moscovici, M., Pereira, A.A., Koch, A., A avaliação videofluoroscópica da transição faringoesofágica (esfíncter superior do esôfago) (1993) Radiologia Brasileira, 23, pp. 71-80Perlman, A.L., Booth, B.M., Grayhack, J.P., Videofluoroscopic predictors of aspiration in patients with oropharyngeal dysphagia (1994) Dysphagia, 9, pp. 90-95Logemann, J.A., Swallowing physiology and pathophysiology (1988) Otolaryngol Clin North Am, 21, pp. 613-623Kandel ER. Linguagem. In Kandel ER, Schwartz JH, Jessel TM. Fundamentos da neurociência e do comportamento. Rio de Janeiro: Guanabara Koogan2000. p. 505-1

Discite em crianças: estudo de oito casos

Os autores apresentam o estudo de oito crianças com diagnóstico de discite estabelecido através da avaliação clínica, neurológica e ortopédica. A comprovação de alterações inflamatórias em um espaço discal, vertebral e em tecidos moles foi possível em estudos por imagem, sendo discutidos aqueles obtidos por radiologia convencional, tomografia computadorizada e ressonância magnética

Diskitis In Children [discite Em Criança]

The authors report clinical review and radiographic appearance of children diagnosed with diskitis. The ambiguous clinical manifestation of diskitis characterized by vague symptoms of pain, mainly in nursing and preschool children, are emphasized. The awareness and recognition by Pediatrician, Neurologist, Orthopedic and Radiologist of the entity of diskitis, is very important for early diagnostic and treatment. Bone scan, CT and MRI are most useful tests for diagnosis, of typical and atypical cases.3239193Coventry, M.B., Ghormley, R.K., Kernhan, J.W., The intervertebral disc: Its microscopic anatomy and pathology (1945) J Bone Joint Surg, 27, pp. 105-112. , AMCrawford, A.H., Kucharzyk, D.W., Ruda, Smitherman, J.R., Diskitis in children (1991) Clin Orthop, 266, pp. 70-79Fisher, G.W., Popich, G.A., Sullivan, D.E., Mayfield, G., Mazat, B.A., Patterson, P.H., Diskitis: A prospective diagnostic analysis (1978) Pediatrics, 62, pp. 543-548Heller, R.M., Szalay, E.A., Green, N.E., Horev, G.D., Kirchner, S.D., Disc space infection in children: Magnetic Resonance Imaging (1988) Radiol Clin North Am, 26, pp. 207-209Kemp, H.B.S., Johns, D.L., Mcalister, J., Godlee, J.N., Pyogenic infections occurring primarily in intervertebral disc (1973) J Bone Joint Surg, 55 B, pp. 698-714King, H.A., Back pain in children (1986) Pediatr Clin North Am, 31, pp. 1083-1086Lacour, M., Duarte, M., Beutler, A., Suter, S., Osteoarticular infections due to Kingella kingae in children (1991) Eur J Pediatr, 150, pp. 612-618Leahy, A.L., Fogarty, E.E., Fitzgerald, R.J., Regan, B.F., Discitis as a cause of abdominal pain in children (1984) Surgery, 95, pp. 412-414Melenaus, M.B., Discitis - An inflammation affecting the intervertebral discs in children (1964) J Bone Joint Surg, 46 B, pp. 16-23Moura-Ribetro, M.V.L., Fernandez, V.L.M., Piovesana, A.M.S.G., Guerreiro, M.M., Mouraribeiro, R., Gonçalves, V.M.G., Discite em crianças: Estudo de oito casos (1994) Arq Neuropsiquiatr, 52, pp. 535-538Petrus, M., Range, F., Clement, J.L., Prere, M.F., Ibanez, M.H., Netter, J.C., Spondylodiscite cervicale à Kingella kingae - A propos d'un cas (1990) An Pediatr, 37, pp. 170-172Sartoris, D.J., Moskowitz, P.S., Kaufman, R.A., Ziprkowski, M.N., Berger, P.E., Childhood diskitis computed tomographic finding (1983) Radiology, 149, pp. 701-707Scoles, P.V., Quinn, T.P., Intervertebral discitis in children and adolescents (1982) Clin Orthop, 162, pp. 31-36Sulivan, C.R., Symmonds, R.E., Disk infection and abdominal pain (1974) JAMA, 188, pp. 655-657Wenger, D.R., Bobechko, W.P., Gilday, D.L., The spectrum of intervertebral disc-space infection in children (1978) J Bone Joint Surg Am, 60 A, pp. 100-10

Cerebrovascular Disease In Children: Ii. Clinical Aspects In 42 Cases [doença Cerebrovascular Na Infância: Ii. Aspectos Clínicos Em 42 Casos]

We report the findings recorded in 42 children suffering cerebrovascular disease and assisted at the Hospital das Clínicas FCM-UNlCAMP, over a 8 years period (January 1990 until April 1998). The ischemic type was the most common, and involvement of the middle cerebral artery, sudden onset of clinical manifestation with seizures and motor disability were more common in early aged children. Motor sequelae predominated in the follow-up of these children.573 A594598Shoenberg, B.S., Mellinger, J.F., Shoenberg, D.G., Cerebrovascular disease in infants and children: A study of incidence, clinical features, and survival (1978) Neurology, 28, pp. 763-768Riela, A.R., Roach, E.S., Etiology of stroke in children (1993) J Child Neurol, 8, pp. 201-220Roach, E.S., Ariela, A.R., (1955) Pediatric Cerebrovascular Disorders. 2.Ed., , New York: FuturaMoura-Ribeiro, M.V.L., Rocha, C.M., Fernandes, W.L.M., Guerreiro, M.M., Meningites bacterianas agudas: Complicações vasculares (1993) Arq Neuropsiquiatr, 51, pp. 507-510Moura-Ribeiro, M.V.L., Pessoto, M.A., Marba, S.T.M., Cerebrovascular disease in neonates (1999) Arq Neuropsiquiatr, 57, pp. 84-87Moura-Ribeiro, M.V.L., (1988) Doença Cerebrovascular em Crianças e Adolescentes, pp. 97-102. , Gagliardi RJ, Reimão R (eds), São Paulo: Lemos EditorialPark, Y.D., Belman, A.L., Kim, T.S., Stroke in pediatric acquired immunodeficiency syndrome (1990) Ann Neurol, 28, pp. 303-311Chiun, C., Delong, G.R., Heinz, E.R., Intracranial fibromuscular dysplasia in a 5 year old child (1996) Pediatr Neurol, 14, pp. 262-264Aylett, S.F., Britton, L., Souza, C.M.P., Down syndrome and moyamoya disease: Presentation with subarachnoid hemorrhage (1996) Pediatr Neurol, 14, pp. 259-261Pavlakis, S.G., Bello, J., Prohovnik, I., Brain infarction in sickle cell anemia: Magnetic resonance imaging correlates (1988) Ann Neurol, 23, pp. 125-130Hess, D.C., Adams, R.J., Nichols, F.T., Sickle cell anemia and other hemoglobinopathies (1991) Semin Neurol, 11, pp. 314-328Arita, F.N., (1998) Acidente Vascular Cerebral em Crianças com Doença Falciforme, , Tese. Faculdade de Ciências Médicas Santa Casa São PauloKendzielka, D., Hgumphreys, R.P., Hoffman, H.J., Arteriovenous malformations of the brain in children: A forty year experience (1992) Can J Neurol Sci, 19, pp. 40-45Zee, C.S., Segall, H.D., McComb, J.G., Intracranial arterial aneurysms in childhood: More recent considerations (1986) J Child Neurol, 1, pp. 99-114Arruda, V., Trombofilias hereditárias: Mecanismos diagnósticos e tratamento (1997) Escola Brasileira de Hematologia, 4, p. 5466Leboreiro-Fernandez, A., Leboreiro, I.E.F., Moura-Ribeiro, M.V.L., Infarto estriato capsular na infância: Relato de 4 casos (1994) Arq Neuropsiquiatr, 52, pp. 396-40