Kindlicher ischämischer Schlaganfall: Wann daran denken? Was unternehmen?

Zusammenfassung: Der kindliche Schlaganfall ist ein seltenes, aber einschneidendes Ereignis. Das Leitsymptom im Notfall ist in 70-80% eine Hemisymptomatik, wobei die Symptome je nach Lokalisation des Infarkts mannigfaltig sein können. Die Verdachtsdiagnose wird durch eine Bildgebung bestätigt. Häufigste auslösende Risikofaktoren sind Infektionen (wie Varizellen), kardiale Probleme, Vaskulopathien (wie Stenosen, Dissektionen, Moyamoya-Erkrankung) und Koagulopathien. Da der kindliche Schlaganfall ein Problem des mehrfachen Risikos ist, ist immer eine umfassende Abklärung notwendig. Die Mortalität beträgt 8-15%; das Rezidivrisiko von 14-19% ist abhängig von den vorliegenden Risikofaktoren. Kinder nach einem arteriellen Schlaganfall zeigen zu etwa 40% neurologische Residualsymptome (am häufigsten Hemiparese), einschneidender für ihren Alltag sind aber die kognitiven Folgen und Verhaltensproblem

Acute transverse myelitis in Lyme neuroborreliosis

Introduction: Acute transverse myelitis (ATM) is a rare disorder (1-8 new cases per million of population per year), with 20% of all cases occurring in patients younger than 18years of age. Diagnosis requires clinical symptoms and evidence of inflammation within the spinal cord (cerebrospinal fluid and/or magnetic resonance imaging). ATM due to neuroborreliosis typically presents with impressive clinical manifestations. Case presentation: Here we present a case of Lyme neuroborreliosis-associated ATM with severe MRI and CSF findings, but surprisingly few clinical manifestations and late conversion of the immunoglobulin G CSF/blood index of Borrelia burgdorferi sensu lato. Conclusion: Clinical symptoms and signs of neuroborrelial ATM may be minimal, even in cases with severe involvement of the spine, as shown by imaging studies. The CSF/blood index can be negative in the early stages and does not exclude Lyme neuroborreliosis; if there is strong clinical suspicion of Lyme neuroborreliosis, appropriate treatment should be started and the CSF/blood index repeated to confirm the diagnosi

Acute transverse myelitis in Lyme neuroborreliosis

Introduction: Acute transverse myelitis (ATM) is a rare disorder (1-8 new cases per million of population per year), with 20% of all cases occurring in patients younger than 18years of age. Diagnosis requires clinical symptoms and evidence of inflammation within the spinal cord (cerebrospinal fluid and/or magnetic resonance imaging). ATM due to neuroborreliosis typically presents with impressive clinical manifestations. Case presentation: Here we present a case of Lyme neuroborreliosis-associated ATM with severe MRI and CSF findings, but surprisingly few clinical manifestations and late conversion of the immunoglobulin G CSF/blood index of Borrelia burgdorferi sensu lato. Conclusion: Clinical symptoms and signs of neuroborrelial ATM may be minimal, even in cases with severe involvement of the spine, as shown by imaging studies. The CSF/blood index can be negative in the early stages and does not exclude Lyme neuroborreliosis; if there is strong clinical suspicion of Lyme neuroborreliosis, appropriate treatment should be started and the CSF/blood index repeated to confirm the diagnosi

Pediatric stroke related to Lyme neuroborreliosis: Data from the Swiss NeuroPaediatric Stroke Registry and literature review.

Cerebrovascular complications of Lyme neuroborreliosis (LNB) are poorly documented in the paediatric population. We performed a retrospective analysis from prospectively registered cases of acute ischemic stroke (AIS) from the Swiss NeuroPaediatric Stroke Registry (SNPSR) from 2000 to 2015. Only cases with serologically confirmed LNB were included. In addition, a literature review on paediatric stroke cases secondary to Lyme neuroborreliosis in the same time frame was performed. 4 children out of 229 children with arterial ischemic childhood stroke and serologically confirmed LNB were identified in the SNPSR giving a global incidence of 1.7%. Median age was 9.9 years. A prior history of tick bites or erythema migrans (EM) was reported in two cases. Clinical presenting signs were suggestive of acute cerebellar/brainstem dysfunction. On imaging, three children demonstrated a stroke in the distribution of the posterior inferior cerebellar artery. The remaining fourth child had a "stroke-like" picture with scattered white matter lesions and a multifocal vasculitis with prominent basilar artery involvement. Lymphocytic pleocytosis as well as intrathecal synthesis of Borrelia burgdorferi antibodies were typical biological features. Acute intravenous third generation cephalosporins proved to be effective with rapid improvement in all patients. No child had recurrent stroke. Data from the literature concerning eight patients gave similar results, with prominent posterior circulation stroke, multifocal vasculitis and abnormal CSF as distinctive features. Lyme Neuroborreliosis accounts for a small proportion of paediatric stroke even in an endemic country. The strong predilection towards posterior cerebral circulation with clinical occurrence of brainstem signs associated with meningeal symptoms and CSF lymphocytosis are suggestive features that should rapidly point to the diagnosis. This can be confirmed by appropriate serological testing in the serum and CSF. Clinicians must be aware of this rare neurological complication of Lyme disease that demands specific antibiotic treatment

Isotropic apparent diffusion coefficient mapping of postnatal cerebral development

Diffusion-weighted imaging (DWI) allows us to image the motion of tissue water. This has been used to demonstrate acute ischaemia. Diffusion imaging is also sensitive to water movement along neuronal tracts. Our objective was to map brain maturation in vivo using maps of apparent diffusion coefficient (ADC). We studied 22children without neurological disease aged between 2 and 720days. MRI was performed at 1.5tesla. Multislice single-shot echoplanar DWI was performed at b 0 and 1000s/mm2. ADC maps were generated automatically and measurements were performed in the basal ganglia, frontal and temporal white matter and the pons. There was a decrease over time in water diffusion in the areas examined, most marked in the frontal (0.887-1.898×10-3mm2/s) and temporal (1.077-1.748×10-3mm2/s)lobes. There was little change, after an initial decrease, in the basal ganglia (0.690-1.336×10-3mm2/s). There was a difference in water diffusion between the anterior (0.687-1.581×10-3mm2/s) and posterior (0.533-1.393×10-3mm2/s) pons. These changes correlate well with those observed in progressive myelination: the increased water content probably reflects incomplete myelination and the decrease with time in water motion reflects the increase in myelinated brai

The neuronal correlates of mirror illusion in children with spastic hemiparesis: a study with functional magnetic resonance imaging.

To investigate the neuronal activation pattern underlying the effects of mirror illusion in children/adolescents with normal motor development and in children/adolescents with hemiparesis and preserved contralateral corticospinal organisation. The type of cortical reorganisation was classified according to results of transcranial magnetic stimulation. Only subjects with congenital lesions and physiological contralateral cortical reorganisation were included. Functional magnetic resonance imaging was performed to investigate neuronal activation patterns with and without a mirror box. Each test consisted of a unimanual and a bimanual motor task. Seven children/adolescents with congenital hemiparesis (10-20 years old, three boys and four girls) and seven healthy subjects (8-17 years old, four boys and three girls) participated in this study. In the bimanual experiment, children with hemiparesis showed a significant effect of the mirror illusion (p<0.001 at voxel level, family-wise error corrected at cluster level) in the dorsolateral prefrontal cortex and anterior cingulate cortex of the affected and unaffected hemispheres, respectively. No significant effects of the mirror illusion were observed in unimanual experiments and in healthy participants. Mirror illusion in children/adolescents with hemiparesis leads to activation of brain areas involved in visual conflict detection and cognitive control to resolve this conflict. This effect is observed only in bimanual training. We consider that for mirror therapy in children and adolescents with hemiparesis a bimanual approach is more suitable than a unimanual approach

Genome Sequences of Rare Human Enterovirus Genotypes Recovered from Clinical Respiratory Samples in Bern, Switzerland.

We report on genomic sequences of human enteroviruses (EVs) that were identified in respiratory samples in Bern, Switzerland, in 2018 and 2019. Besides providing sequences for coxsackievirus A2, echovirus 11, and echovirus 30, we determined the sequences of rare EV-D68 and EV-C105 genotypes circulating in Switzerland

CCD photometric search for peculiar stars in open clusters. VII. Berkeley 11, Berkeley 94, Haffner 15, Lynga 1, NGC 6031, NGC 6405, NGC 6834 and Ruprecht 130

The detection of magnetic chemically peculiar (CP2) stars in open clusters of the Milky Way can be used to study the influence of different galactic environments on the (non-)presence of peculiarities, which has to be taken into account in stellar evolution models. Furthermore it is still unknown if the CP2 phenomenon evolves, i.e. does the strength of the peculiarity feature at 5200A, increase or decrease with age. We have observed eight young to intermediate age open clusters in the Delta a photometric system. This intermediate band photometric system samples the depth of the 5200A, flux depression by comparing the flux at the center with the adjacent regions having bandwidths of 110A, to 230A. The Delta a photometric system is most suitable to detect CP2 stars with high efficiency, but is also capable of detecting a small percentage of non-magnetic CP objects. Also, the groups of (metal-weak) lambda Bootis, as well as classical Be/shell stars, can be successfully investigated. This photometric system allows one to determine the age, reddening and distance modulus by fitting isochrones. Among the presented sample of eight galactic clusters, we have detected twenty three CP2, eight Be/Ae and eight metal-weak stars. Another six objects show a peculiar behaviour which is most probably due to a non-membership,variability or duplicity. Fitting isochrones to Delta a photometry yields estimates of the age, reddening and distance that are in excellent agreement with published values