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Resume L’alimentation de l’enfant porteur de polyhandicap, comme dans les formes severes de paralysie cerebrale, est un sujet de preoccupation au quotidien pour les parents et les equipes de reeducation presentes autour de lui. En effet, le plaisir et la convivialite du repas peuvent etre contraries par les difficultes de posture, de deglutition, de digestion ou encore des douleurs. L’evaluation reguliere de la croissance staturo-ponderale est necessaire selon des criteres adaptes a la population des enfants en situation de polyhandicap car le risque de denutrition est important. Nous decrivons les mecanismes a l’origine des difficultes alimentaires et nous proposons des mesures d’intervention et de prevention nutritionnelles.

Management of pain is one of the major expectations of children with neurological impairment and their families. The medical literature is poor on this topic accounting for approximately 0.15 % of the publications on pain in general. The objective of the French Pediatric Neurology Society was to review the current knowledge on this topic. Bibliographic research was conducted with PubMed and RefDoc for publications between 1994 and 2014 in French or English. A total of 925 articles were retrieved and 92 were selected for review. Pain is common in this population: a 2-week survey indicated that pain occurs in 50-75 % of children. Pain negatively impacts the quality of life of children and their parents. Children with neurological impairment express their pain with pain expression patterns and specific patterns common to children (change of tone, abnormal movements, spasticity, paradoxical reactions, such as laughter, self-injury or vasomotor dysfunction). Some children with neurological impairment are able to use self-report pain scales. If not, observational measures should be used. Behavioral rating scales specifically designed for this population are more sensitive than others. Scales must be selected according to children's communication skills, type of pain, and the context. Sometimes behavioral changes are the only expression of pain: any change in sleep, tone, feeding, or mood must suggest pain in this population. Management of pain remains difficult. There are no specific guidelines. Procedural pain management guidelines and the usual analgesic drugs can be used in children with neurological impairment with specific concerns regarding tolerance and side effects. These children are particularly at risk for neuropathic pain. A multidisciplinary approach is helpful, involving physicians, nurses, physiotherapists, psychologists and parents.

In 2005, the French law on patients' rights at the end of life required that decisions to withdraw or withhold life-sustaining treatments be made and carried out by the physician in charge of the patient, after obtaining advice from an independent consulting colleague and the caregiving team. The purpose of this study was to identify theoretical and practical obstacles to this collaborative deliberation and to propose practical guidelines to organize it.

Resume L’encephalite auto-immune a anticorps antirecepteurs au N-Methyl-D-Aspartate (NMDA) est une atteinte grave du systeme nerveux central, encore peu connue des cliniciens, pouvant etre a l’origine de symptomes psychiatriques frustres comportant des symptomes psychotiques ou catatoniques. Nous rapportons ici le cas d’une jeune fille de 15 ans, sans antecedent personnel notable, hospitalisee pour decompensation psychotique de debut brutal, rapidement compliquee d’une catatonie agitee puis stuporeuse, repondant insuffisamment au traitement par benzodiazepines. Le diagnostic d’encephalite a anticorps anti-RNMDA a pu etre confirme par le dosage des auto-anticorps dans le liquide cephalorachidien (LCR). L’evolution sera favorable sous corticoides et immunosuppresseurs. Nous proposons a l’issue de ce cas, une mise au point sur l’encephalite a auto-anticorps anti-RNMDA et sur l’hypothese d’un desequilibre de la balance excitation/inhibition a l’origine de la catatonie.

Resume Position du probleme L’intoxication au monoxyde de carbone (CO) est la premiere cause de deces par intoxication en France. Ses consequences sont potentiellement graves pour le fœtus. La litterature est ancienne et peu connue. But et methode Faire un etat des lieux des connaissances concernant l’intoxication au CO pendant la grossesse. Resultat Le CO entraine une hypoxie tissulaire maternelle puis fœtale, principalement par fixation a l’hemoglobine avec laquelle il a une grande affinite. Son passage transplacentaire peut entrainer des lesions fœtales, principalement au niveau cerebral. Leur gravite semble correlee a la symptomatologie maternelle lors de l’exposition. En l’absence de symptomes maternels en revanche, les donnees dont nous disposons sont rassurantes. L’oxygenotherapie hyperbare pourrait reduire les risques fœtaux. Discussion L’oxygenotherapie devrait pouvoir etre proposee dans tous les cas d’intoxication au CO, en particulier s’il existe des symptomes maternels lors de l’exposition. Par ailleurs, une echographie fœtale orientee sur le pole cephalique – voire une imagerie par resonance magnetique fœtale trois semaines apres une exposition – devrait egalement etre proposee.

Management of pain is one of the major expectations of children with neurological impairment and their families. The medical literature is poor on this topic accounting for approximately 0.15 % of the publications on pain in general. The objective of the French Pediatric Neurology Society was to review the current knowledge on this topic. Bibliographic research was conducted with PubMed and RefDoc for publications between 1994 and 2014 in French or English. A total of 925 articles were retrieved and 92 were selected for review. Pain is common in this population: a 2-week survey indicated that pain occurs in 50-75 % of children. Pain negatively impacts the quality of life of children and their parents. Children with neurological impairment express their pain with pain expression patterns and specific patterns common to children (change of tone, abnormal movements, spasticity, paradoxical reactions, such as laughter, self-injury or vasomotor dysfunction). Some children with neurological impairment are able to use self-report pain scales. If not, observational measures should be used. Behavioral rating scales specifically designed for this population are more sensitive than others. Scales must be selected according to children's communication skills, type of pain, and the context. Sometimes behavioral changes are the only expression of pain: any change in sleep, tone, feeding, or mood must suggest pain in this population. Management of pain remains difficult. There are no specific guidelines. Procedural pain management guidelines and the usual analgesic drugs can be used in children with neurological impairment with specific concerns regarding tolerance and side effects. These children are particularly at risk for neuropathic pain. A multidisciplinary approach is helpful, involving physicians, nurses, physiotherapists, psychologists and parents.

Gyration abnormalities often reflect severe neurological diseases. Their diagnosis is impeded by our limited knowledge about normal sulci anatomy throughout fetal brain development. Primary sulci appears in a specific chronology which is unchanged among all fetuses. We think it is interesting to remind of sulci anatomy and then to depict sulci MRI and ultrasonography appearance at 22, 27 and 32 weeks of gestation. We pay particular attention to the lateral sulcus, also called Sylvian fissure.

La diastematomyelie est une malformation rachidienne rare caracterisee par la presence d’un eperon median fibreux ou osseux separant la moelle en deux hemimoelles. Nous rapportons le cas d’une diastematomyelie diagnostiquee a l’echographie antenatale morphologique. Le diagnostic a ete confirme par l’imagerie par resonance magnetique (IRM) postnatale, alors que l’IRM antenatale evoquait le diagnostic de myelolipome lombosacre. Le diagnostic antenatal repose sur des signes echographiques specifiques. Nous discutons de l’interet de l’IRM fœtale, faite en seconde intention, dans l’evaluation du diagnostic et du pronostic de cette malformation.

Tuberous sclerosis complex is a genetic multisystem disease characterized by hamartic development of many organs, most notably the brain, heart, kidneys, lungs, and skin. This autosomic dominant disorder results from mutations in one of two genes, TSC1 and TSC2, coding for hamartin and tuberin, respectively. The hamartin-tuberin complex inhibits the mammalian target of rapamycin pathway, which controls cell growth and proliferation. The clinical presentation is highly variable and most features of tuberous sclerosis become evident only in childhood after the child is several years of age, limiting their usefulness for early diagnosis. The aim of this article is to define the pediatric clinical manifestations of tuberous sclerosis in correlation with patient age. Sometimes, a prenatal diagnosis can be made based on fetal ultrasound and MRI, which show cardiac and brain lesions. However, newborns are most often asymptomatic. In the 1st year, seizures are the most common symptoms, with a high incidence of infantile spasms. In children between 2 and 10 years of age, neurological symptoms are the most frequent with epilepsy, mental retardation, and autism, but extraneurological manifestations can be diagnosed. In adolescents, most features of tuberous sclerosis become evident and renal and pulmonary manifestations must be sought. The knowledge of age-dependent clinical features of tuberous sclerosis can provide an earlier diagnosis and improve the management of these patients with a special role for multidisciplinary consultation.

Malgre les progres de la reanimation, la mortalite neonatale des enfants porteurs de HCD reste elevee, proche de 30–40 %, essentiellement du fait de l’hypoplasie pulmonaire et d’une hypertension arterielle pulmonaire. Les principales sequelles observees sont respiratoires (HTAP chronique, dysplasie bronchopulmonaire, susceptibilite aux infections virales), digestives (reflux gastro-oesophagien, trouble de l’oralite), nutritionnelles (denutrition d’origine multifactorielle: RGO, trouble de l’oralite, insuffisance respiratoire) et orthopediques (scoliose). La prise en charge actuelle de ces complications est tardive: elle necessite une intervention plus precoce, qui doit debuter des la periode neonatale. Les objectifs de la prise en charge medicale seront: 1) d’assurer une oxygenation tissulaire et la decarboxylation tout en minimisant le baro-volotraumatisme du poumon; 2) d’assurer une fonction circulatoire adequate en limitant les consequences de l’HTAP; 3) de prevenir la morbidite respiratoire et digestive. Elle necessite imperativement un suivi et une prise en charge multidisciplinaire specialisee, du fait de l’intrication de ces differentes complications.

International audience; In 2005, the French law on patients’ rights at the end of life required that decisions to withdraw or withhold life-sustaining treatments be made and carried out by the physician in charge of the patient, after obtaining advice from an independent consulting colleague and the caregiving team. The purpose of this study was to identify theoretical and practical obstacles to this collaborative deliberation and to propose practical guidelines to organize it.; La loi du 22 avril 2005 relative aux droits des malades et à la fin de vie, dite « loi Leonetti », a instauré l’obligation d’une délibération collégiale avant les décisions de limitation ou d’arrêt des traitements (LAT) pour les patients hors d’état d’exprimer leur volonté. Les modalités de cette collégialité ont été précisées par le décret du 6 février 2006 qui impose au médecin en charge du patient de prendre l’avis d’un confrère appelé à titre de consultant avant toute décision de LAT et de consulter l’équipe soignante. L’objectif de cette étude était de repérer les obstacles théoriques et pratiques à l’exercice de la collégialité et de proposer des éléments d’organisation pour les contourner.

Autism is defined by 3 main criteria: disturbance of reciprocal social interaction, disturbance of communication (including language comprehension and spoken language) and disturbance of normal variation in behaviour and imaginative activities; an onset before age 36 months is also required. The neuropediatric contribution to autism is dominated by the search for an underlying organic etiology, especially if there are arguments for an associated encephalopathy: ante- or perinatal medical history, dysmorphic signs, skin spots, neurological abnormalities, somatic abnormalities compatible with a neurometabolic disorder. The main associated conditions with autism are: chromosome anomalies, monogenic syndrome (including fragile X syndrome), neurocutaneous syndromes, epileptic encephalopathies, neurometabolic diseases, and dystrophinopathies. The identification of an associated medical condition to autism is primordial in prospect of genetic counselling, and by the change induced in familial perception of autism.

Migraine, according to the criteria of the International Headache Society, occurs in about 5 to 10% of children. Management of acute headache is only one of the parts of the treatment, along with identification of migraine precipitants, adjustments in lifestyle, and when necessary the use of preventive therapy, which can include non pharmacologic (relaxation or biofeedback) or pharmacologic treatment. In the acute migraine attack, a single dose of either ibuprofen 10 mg/kg or paracetamol 15 mg/kg has been shown to be effective, with only a few adverse effects. In severe migraine attacks, dihydroergotamine mesylate administered orally (20 to 40 microg/kg) or intravenously (maximum 1 mg/day) may be helpful, but there have been no large placebo-controlled trials of this treatment. Among the different triptans, it is the sumatriptan nasal spray whose efficacy has been best demonstrated. The most frequent adverse event is transitory unpleasant taste.

Migraine, according to the criteria of the International Headache Society, occurs in about 5-10% of children. Preventive therapy includes identification of migraine precipitants, possible adjustments in lifestyle, appropriate management of acute headache, and when necessary the use of pharmacologic agents. It should be started if migraine attacks are severe or frequent. Non-pharmacologic prophylactic treatment is the modality of choice, based on relaxation or biofeedback. Despite its high incidence, only a few controlled trials have investigated the prophylactic treatment of migraine in children. Only flunarizine (5 mg/day) has been shown to be effective in two double-blind, placebo-controlled trials. Some evidence also exists that propranolol (60 mg/day) and pizotifen (0.5-1.5 mg/day) are effective. For all other drugs studied in migraine prophylaxis, the results remain vague (e.g. amitriptyline), or suggest inefficacy (e.g. clonidine, tryptophane). Most of the drugs used in the treatment of migraine in children are well tolerated. The most common adverse effects are drowsiness and bodyweight gain.

Resume Buts de l’etude. – Evaluation d’une politique de prescription de l’erythropoietine (EPO) et description des nouveau-nes traites a risque de transfusion de globules rouges (TGR). Type d’etude. – Etude prospective, descriptive. Population et methodes. – Cent soixante-cinq nouveau-nes d’âge gestationnel (AG) inferieur a 30 semaines et/ou de poids de naissance inferieur a 1000 g hospitalises de mai 1998 a octobre 1999. Quatre-vingt-dix exclus (malformations congenitales n = 6, deces n = 16, enfants transferes avant le retour au domicile n = 67, oxygenation membranaire extracorporelle n = 1). Les donnees concernant les caracteristiques de la population, la severite de la pathologie neonatale, le taux d’hemoglobine a la naissance, les facteurs de depletion sanguine, le traitement par EPO, le nombre de TGR et de donneurs etaient analysees. Resultats. – Trente-huit des soixante-quinze (51 %) enfants traites ont ete transfuses. Ils ont recu 112 TGR, dont 88 tardives, au-dela de J15. Dans la majorite des cas (n = 68), ces transfusions tardives ont ete prescrites dans le cadre du protocole utilise. Vingt fois (23 %) elles ont ete realisees au decours d’une septicemie nosocomiale. Le nombre de donneurs par enfant etait de 2,3 ± 1,6 [1] , [2] , [3] , [4] , [5] , [6] , [7] . La prescription d’EPO etait comparable dans les groupes d’enfants non transfuses (groupe I) et transfuses (groupe II) : introduction precoce de l’erythropoietine a 3 ± 2 j dans les deux groupes, nombre d’injections (17 ± 4 vs 18 ± 1, ns). L’introduction du fer etait tardive (12 j ± 8 vs 19 j ± 10, ns). Le groupe II avait un poids de naissance plus faible (850 ± 240 vs 1050 ± 160 g, p Conclusion. – Dans cette population, la qualite de prescription de la supplementation martiale, des TGR et le respect du protocole de donneur unique sont susceptibles d’etre ameliores. Les nouveau-nes d’AG inferieur a 30 semaines et/ou de poids de naissance inferieur a 1000 g traites precocement par EPO et transfuses sont plus hypotrophes et plus malades. L’identification precoce de cette population pourrait permettre d’ameliorer les strategies preventives et l’efficacite du traitement.

The poisoning of carbon monoxide (CO) is the leading cause of death by poisoning in France. Its consequences are potentially serious to the fetus. Literature is ancient and little known.Make an inventory of knowledge about carbon monoxide poisoning during pregnancy.The CO causes maternal then fetal tissue hypoxia primarily by binding to hemoglobin with which it has a high affinity. Its transplacental passage may cause fetal harm, predominantly in the brain. Severity seems correlated with maternal symptoms during exposure. In the absence of maternal symptoms, however, the available data are reassuring. Hyperbaric oxygen therapy may reduce the risk to the fetus.Oxygen therapy should be offered in all cases of CO poisoning, especially if there are maternal symptoms during exposure. In addition, a fetal echography directed on the cephalic pole - even a fetal magnetic resonance imaging three weeks after exposure - should also be proposed.

Gyration abnormalities often reflect severe neurological diseases. Their diagnosis is impeded by our limited knowledge about normal sulci anatomy throughout fetal brain development. Primary sulci appears in a specific chronology which is unchanged among all fetuses. We think it is interesting to remind of sulci anatomy and then to depict sulci MRI and ultrasonography appearance at 22, 27 and 32 weeks of gestation. We pay particular attention to the lateral sulcus, also called Sylvian fissure.

In 2005, the French law on patients' rights at the end of life ratified that decisions to withdraw or withhold life-sustaining treatments must be made and carried out by the physician in charge of the patient, after obtaining the advice of an independent consulting colleague. The purpose of this text is to put forward the perspective of a pediatric multidisciplinary workshop regarding the role of the consulting physician and to propose guidelines to help choose this consultant.

In 2005, the French law on patients’ rights at the end of life ratified that decisions to withdraw or withhold life-sustaining treatments must be made and carried out by the physician in charge of the patient, after obtaining the advice of an independent consulting colleague. The purpose of this text is to put forward the perspective of a pediatric multidisciplinary workshop regarding the role of the consulting physician and to propose guidelines to help choose this consultant., La loi du 22 avril 2005 relative aux droits des malades et à la fin de vie (dite « loi Leonetti ») a donné un cadre légal aux décisions de limitation et d’arrêt de traitement (LAT) et a instauré l’obligation d’une délibération collégiale pour les patients hors d’état d’exprimer leur volonté. Les modalités de cette collégialité ont été précisées par le décret du 6 février 2006 qui impose au médecin en charge du patient de prendre l’avis motivé d’un consultant avant toute décision de LAT. Ces dispositions qui ont été intégrées dans l’article 37 du Code de déontologie médicale, nécessitent leur appropriation dans des disciplines dont la culture et la temporalité sont très différentes. En pédiatrie, l’application de cette loi doit tenir compte du rôle des parents puisque, sur le plan légal, l’enfant est représenté par ses parents, qu’il soit ou non en état d’exprimer sa volonté. L’objectif de ce texte est de définir les situations requérant la présence d’un consultant au sens de la loi Leonetti en pédiatrie, de préciser son positionnement et son rôle, et de proposer des éléments d’orientation pour en guider le choix en pratique.

Tuberous sclerosis complex is a genetic multisystem disease characterized by hamartic development of many organs, most notably the brain, heart, kidneys, lungs, and skin. This autosomic dominant disorder results from mutations in one of two genes, TSC1 and TSC2, coding for hamartin and tuberin, respectively. The hamartin-tuberin complex inhibits the mammalian target of rapamycin pathway, which controls cell growth and proliferation. The clinical presentation is highly variable and most features of tuberous sclerosis become evident only in childhood after the child is several years of age, limiting their usefulness for early diagnosis. The aim of this article is to define the pediatric clinical manifestations of tuberous sclerosis in correlation with patient age. Sometimes, a prenatal diagnosis can be made based on fetal ultrasound and MRI, which show cardiac and brain lesions. However, newborns are most often asymptomatic. In the 1st year, seizures are the most common symptoms, with a high incidence of infantile spasms. In children between 2 and 10 years of age, neurological symptoms are the most frequent with epilepsy, mental retardation, and autism, but extraneurological manifestations can be diagnosed. In adolescents, most features of tuberous sclerosis become evident and renal and pulmonary manifestations must be sought. The knowledge of age-dependent clinical features of tuberous sclerosis can provide an earlier diagnosis and improve the management of these patients with a special role for multidisciplinary consultation.

Autism is defined by 3 main criteria: disturbance of reciprocal social interaction, disturbance of communication (including language comprehension and spoken language) and disturbance of normal variation in behaviour and imaginative activities; an onset before age 36 months is also required. The neuropediatric contribution to autism is dominated by the search for an underlying organic etiology, especially if there are arguments for an associated encephalopathy: ante- or perinatal medical history, dysmorphic signs, skin spots, neurological abnormalities, somatic abnormalities compatible with a neurometabolic disorder. The main associated conditions with autism are: chromosome anomalies, monogenic syndrome (including fragile X syndrome), neurocutaneous syndromes, epileptic encephalopathies, neurometabolic diseases, and dystrophinopathies. The identification of an associated medical condition to autism is primordial in prospect of genetic counselling, and by the change induced in familial perception of autism.

Migraine, according to the criteria of the International Headache Society, occurs in about 5 to 10% of children. Management of acute headache is only one of the parts of the treatment, along with identification of migraine precipitants, adjustments in lifestyle, and when necessary the use of preventive therapy, which can include non pharmacologic (relaxation or biofeedback) or pharmacologic treatment. In the acute migraine attack, a single dose of either ibuprofen 10 mg/kg or paracetamol 15 mg/kg has been shown to be effective, with only a few adverse effects. In severe migraine attacks, dihydroergotamine mesylate administered orally (20 to 40 microg/kg) or intravenously (maximum 1 mg/day) may be helpful, but there have been no large placebo-controlled trials of this treatment. Among the different triptans, it is the sumatriptan nasal spray whose efficacy has been best demonstrated. The most frequent adverse event is transitory unpleasant taste.

To evaluate a policy of treatment with human recombinant erythropoietin (rhEPO) and to describe factors related to red blood cell transfusions (RBCTs) in treated neonates.Prospective, observative study.One-hundred and sixty-five neonates with gestational age (GA)30 weeks and/or birthweight1000g admitted between may 1998 and october 1999. Ninety were excluded (congenital malformations n = 6, deaths n = 16, referral to a general hospital before discharge n = 67, ECMO n = 1). Data about the characteristics of the population, the severity of the neonatal period, hemoglobin at birth, blood loses, treatment with rhEPO, number of red blood cells transfusions (RBCTs) and donors were recorded in all infants.Thirty-eight in seventy-five (51%) neonates received 112 blood transfusions. Eighty-eight were prescribed after day 15. In most of the cases (n = 68), RBCTs were done according to the protocol. In 20 cases (23%) infants were transfused during a late-onset infection. No difference was observed between the non-transfused (group I) and the transfused neonates (group II) with regards to the drug administration: first dose on day 3 +/- 2, number of injections (17 +/- 4 vs 18 +/- 1, ns). The start of oral supplementation with iron was late (12j +/- 8 vs 19j +/- 10, ns). Infants in group II had a lower birthweight (850 +/- 240 vs 1050 +/- 160 g, p0,01) for a similar GA (28 +/- 1SA vs 28 +/- 2SA, ns) in association with an increased number of small for date babies (p = 0.03). Antenatal steroïds administration (89 vs 74%, ns), administration of surfactant (59 vs 81%, ns) were similar in the two groups. The Clinical Risk Index for Babies was higher in group II: 5 +/- 3 vs 2 +/- 1 (p0,001) as was the duration of oxygen delivery (53 +/- 44 vs 14 +/- 20 days, p0,01) and postnatal administration of corticosteroïds ( 38% vs 3%, p0.01).The quality of iron administration, RBCTs and the limitation of donors could be improved in our population. Transfusions among neonates born before 30 weeks and/or with a birthweight of less than 1000 g and treated with rhEPO are associated with intrauterine malnutrition and a worse clinical condition on admission. Early identification of at risk neonates could improve prevention of RBCTs and the efficacy of rhEPO administration to preterm infants.

Migraine, according to the criteria of the International Headache Society, occurs in about 5-10% of children. Preventive therapy includes identification of migraine precipitants, possible adjustments in lifestyle, appropriate management of acute headache, and when necessary the use of pharmacologic agents. It should be started if migraine attacks are severe or frequent. Non-pharmacologic prophylactic treatment is the modality of choice, based on relaxation or biofeedback. Despite its high incidence, only a few controlled trials have investigated the prophylactic treatment of migraine in children. Only flunarizine (5 mg/day) has been shown to be effective in two double-blind, placebo-controlled trials. Some evidence also exists that propranolol (60 mg/day) and pizotifen (0.5-1.5 mg/day) are effective. For all other drugs studied in migraine prophylaxis, the results remain vague (e.g. amitriptyline), or suggest inefficacy (e.g. clonidine, tryptophane). Most of the drugs used in the treatment of migraine in children are well tolerated. The most common adverse effects are drowsiness and bodyweight gain.

Objectifs Caracteriser en IRM cerebrale fœtale les formations kystiques peri-ventriculaires et aborder leur pronostic. Materiels et methodes Analyse retrospective des IRM de vingt fœtus montrant deux types de lesions : pseudo-kystes sous-ependymaires (PKSE) au niveau des sillons thalamo-caudes et kystes des cornes frontales (KCF) au niveau des angles supero-externes des cornes frontales. Confrontation avec les donnees du suivi de grossesse puis de l’enfant. Resultats Huit fœtus presentaient des KCF, huit des PKSE et quatre une association des deux. Les PKSE etaient sensiblement plus petits que les KCF. Ils etaient toujours unilobes, les KCF parfois plurilobes. Quasiment toutes les lesions etaient ovalaires, de contours reguliers et toujours cernees par un parenchyme de signal normal. D’autres anomalies, cerebrales ou non, s’associaient toujours aux PKSE et dans six cas aux KCF. Le developpement neurologique des enfants semblait meilleur en cas de KCF. Conclusion Hormis leur localisation, quelques elements morphologiques distinguent PKSE et KCF mais sans presumer d’une etiologie. Les PKSE ne sont jamais isoles dans notre serie et leur pronostic semble mauvais mais pas toujours. Les KCF, en general consideres en post-natal comme une variante de la normale, semblent rarement isoles.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 34 - N° 2 - p. 199