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Provides information on a study which tested the hypothesis that increased brain oxygen consumption during hypoglycemic coma is temperature dependent and coincides with increased excitatory amino acids. Account of related publications; Materials and methods; Results and discussion.

An 8-week-old infant presented with Arizona hinshawii meningitis and bacteraemia. The child responded well to the administration of parenteral ampicillin and chloramphenicol. However, chloramphenicol was discontinued after one day of therapy, and A. hinshawii was recultured from the cerebrospinal fluid on the fifth day. Chloramphenicol therapy was restarted and the patient had an uneventful recovery. This report is the first description of A. hinshawii meningitis and should alert clinicians to the possible occurrence of this infection in endemic areas. [ABSTRACT FROM PUBLISHER]

BACKGROUND Cerebral venous thrombosis (CVT) in children is associated with considerable mortality and morbidity, but the long-term risk of a second cerebral or systemic venous thrombosis (VT) event has not received much attention in the literature. The effect of predisposing factors on the risk of recurrence is, therefore, unknown, and the guidelines for secondary prophylactic anticoagulation in children with CVT have been adapted from adult protocols. OBJECTIVE To determine the recurrence rate of symptomatic VT, and to identify predictors of VT recurrence. DESIGN AND INTERVENTION This European cohort study enrolled 396 consecutive patients from Belgium, Germany, Israel and the UK who had a first symptomatic CVT; patients were recruited regardless of the presence of prothrombotic risk factors. The enrollment period was July 1996 to August 2005. CVT was diagnosed using standard imaging methods, i.e. duplex sonography (in neonates only), MRI, and CT or magnetic resonance venography and angiography. Preterm infants and patients older than 19 years were excluded. Acute anticoagulation with unfractionated heparin or low-molecular-weight heparin (LMWH) was administered to 250(65%) children. Secondary anticoagulation prophyIaxis with LMWH or warfarin was provided in 165 (43%) cases. Surviving patients were followed up for a median of 36 months (range 0.1-85 months). The Cox proportional hazards model was used to evaluate the independent contributions of age at onset, underlying medical conditions, nonadministration of secondary prophylactic anticoagulation, neuroimaging data, and presence of prothrombotic risk factors to the risk of recurrent VT OUTCOME MEASURES The primary outcome measure was the recurrence rate of symptomatic VT per 1,000 person-years. Secondary outcome measures included the time to relapse and the relevance of clinical, laboratory and radiological risk factors to symptomatic recurrence. RESULTS Of the 396 children enrolled, 12 died immediately, so the final analysis included 384 patients (60% boys) with a median age of 5.2 years. A second VT event occurred in 22 of the surviving children, at a median of 6 months (range 0.1-85 months) after the index event. VT recurred only in patients who were older than 2 years (range 2.5-16.2 years) at the index event. The recurrence rate per 1,000 person-years was 21.2(95% 0113.9- 32.1) for the entire cohort and 29.1 (95% CI 18.9-44.7) for children older than 2 years. The risk of relapse was significantly increased in patients who did not receive anticoagulation before the relapse event (hazard ratio [HR] 11.2, 95% CI 3.4-37.0; P<0.0007), those with persistent occlusion on repeat venous imaging (HR 4.1, 95% CI 1.1-14.8; P=0.032), and those with heterozygosity for the G20210A mutation in factor II (HR 4.3, 95% CI 1.1-16.2; P=0.034). Underlying medical conditions had no effect on VT recurrence. CONCLUSION The risk of VT recurrence in children with CVT is increased in those who are older than 2 years, those who do not receive secondary anticoagulation prophylaxis, those who fail to recanalize, and those who have the G20210A mutation in factor II. [ABSTRACT FROM AUTHOR]

Background: Moyamoya syndrome (MMS) is a progressive cerebral arteriopathy with increased incidence in children with neurofibromatosis type 1 (NF1). Despite the potential for significant neurological morbidity including stroke, little is known about the natural history, and no guidelines exist for screening and management of NF1-associated MMS., Methods: We identified 152 literature cases of children aged ≤18 years with NF1-associated MMS. A meta-analysis was performed evaluating clinical and neuroimaging findings and patient outcomes. Data from 19 patients with NF1-associated MMS from our center treated from January 1995 to July 2020 were abstracted via chart review and similarly analyzed for clinical and neuroimaging features., Results: Meta-analysis of literature cases showed a median age of MMS diagnosis of 6 years (interquartile range 3 to 10.8 years). Optic pathway gliomas were more common in patients with MMS (42%) compared with historical prevalence. Stroke or transient ischemic attack (TIA) was present at diagnosis in 46%. TIA and stroke were more common in patients with bilateral versus unilateral MMS (62% vs 34%, P = 0.001) and in children aged <4 years versus those aged ≥4 years (61% vs 40%, P = 0.02). Compared with the literature cases, our cohort was more frequently asymptomatic (42% vs 25%) and less likely to present with TIA or stroke (32% vs 46%) at diagnosis., Conclusions: These data suggest there is an aggressive form of MMS in children with NF1 <4 years of age. Therefore, early screening should be considered to facilitate early detection and treatment of cerebral arteriopathy., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: Children with perinatal stroke are at increased risk for developmental language disorders, learning difficulties, and other mental health conditions. However to date, autism (ASD) prevalence in this group has not been reported. Given that early identification of ASD is essential to promoting optimal outcomes, our goal was to establish prevalence of ASD in children with perinatal stroke., Method: A prospectively enrolled, single-center stroke registry maintained at our institution since 2005 was queried for all potentially eligible patients with a history of perinatal stroke. Information regarding stroke features, ASD diagnosis/concern, intellectual disability/global developmental delay, cerebral palsy/hemiparesis, epilepsy, and language disorder were collected via retrospective chart review from electronic health records., Results: 311 children were identified, of which 201 complete records were analyzed. Twenty-three cases were formally diagnosed with ASD (11.4%). First concerns were noted in toddlerhood (Mage = 2.66 years), yet the average age of diagnosis was 6.26 years. Children with ASD were more likely to have earlier diagnoses of intellectual disability/global developmental delay or a mixed receptive-expressive language disorder ( p s < .001) but did not differ on CP/hemiplegia or epilepsy diagnoses. Risk for ASD increased with accumulating diagnoses., Discussion: Children with perinatal stroke have an increased prevalence of ASD (11.4%) than in the general population. ASD concerns arise at a similar age as the general population, yet ASD is diagnosed almost two years later than the general population and 3.60 years after first concerns present. Co-occurring neurological conditions are common. Clinicians must be aware of increased prevalence and implement screening as part of routine care for all pediatric patients with perinatal stroke.