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Amanda Leong, BSc I Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta, Canada i Amalia Floer I Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta, Canada i Adam Kirton, MD I Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta, Canada, Department of Pediatrics and Clinical Neurosciences, Alberta Children's Hospital, Calgary, Alberta, Canada i Aleksandra Mineyko, MD I Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta, Canada, Department of Pediatrics and Clinical Neurosciences, Alberta Children's Hospital, Calgary, Alberta, Canada i References 1 Chabrier S, Peyric E, Drutel L; et al. Thank you for forwarding to us the correspondence from Garel et al in response to our article "Head circumference trajectory in children with perinatal stroke.". [Extracted from the article]

Occipital bone compression of the superior sagittal sinus occurs in supine neonates. The authors previously showed that this compression is associated with neonatal cerebral sinovenous thrombosis, an important neonatal neurological condition, presumably via increased venous stasis. They hypothesized that a pillow alleviating occipital compression could improve cerebral venous flow. Neonates without cerebral sinovenous thrombosis requiring brain magnetic resonance imaging/venography were prospectively enrolled. Demographics, imaging indications, head position, and superior sagittal sinus compression were recorded. Flow velocities in the anterior and posterior superior sagittal sinus and sigmoid sinus before and after pillow placement were quantified using Doppler ultrasound. A total of 10 neonates (6 female, median postconceptional age 40.6 weeks) were enrolled. Flow velocities increased beyond the superior sagittal sinus compression point following pillow placement: 0.09 ± 0.04 m/sec to 0.15 ± 0.12 m/sec (P = .047) for posterior superior sagittal sinus; 0.10 ± 0.05 m/sec to 0.19 ± 0.15 m/sec (P = .005) for sigmoid sinus. Pillow decompression can improve neonatal cerebral venous flow, representing a potential noninvasive intervention for the prevention and treatment of neonatal cerebral sinovenous thrombosis. [ABSTRACT FROM AUTHOR]

Mitochondrial diseases are increasingly being recognized as causes of encephalopathy and intractable epilepsy. There is no gold-standard test for diagnosing mitochondrial disease, and the current diagnosis relies on establishing a consistent pattern of evidence from clinical data, neuroimaging, tissue biopsy, and biochemical, genetic, and other investigations. Experience in the diagnosis and treatment of patients with certain forms of mitochondrial disease, such as Alpers syndrome, is largely gained from case reports or small case series. The authors describe a case of Alpers syndrome due to POLG1 mutations, including serial neuroimaging and pathological investigations, to illustrate two main points: (1) Unique characteristics evident on serial diffusion-weighted imaging can be a valuable indicator of Alpers syndrome; and (2) abnormal lipid metabolism can be present in Alpers syndrome, which may need to be considered when using a ketogenic diet. [ABSTRACT FROM PUBLISHER]

The incidence of spinal injuries is increased in people with epilepsy although compressive thoracic myelopathy has not been reported. We describe a 15-year-old girl with SCN1A mutation (Dravet syndrome), refractory generalized tonic-clonic seizures, and prior posterior instrumentation and fusion for scoliosis, who presented with progressive lower extremity weakness. Junctional kyphosis with disc herniation and spinal cord compression directly rostral to the instrumentation was apparent on imaging. On history, the patient had suffered a particularly severe convulsive seizure just before developing symptoms. Surgical decompression and stabilization led to a complete neurologic recovery. This unusual presentation of myelopathy illustrates the need to consider this complication in patients with epilepsy and spinal instrumentation. [ABSTRACT FROM AUTHOR]