Cerebral proton magnetic resonance spectroscopic imaging in a neonate with tuberous sclerosis

Neonatal Hypoxia Ischaemia: Mechanisms, Models, and Therapeutic Challenges

Neonatal hypoxia-ischaemia (HI) is the most common cause of death and disability in human neonates, and is often associated with persistent motor, sensory, and cognitive impairment. Improved intensive care technology has increased survival without preventing neurological disorder, increasing morbidity throughout the adult population. Early preventative or neuroprotective interventions have the potential to rescue brain development in neonates, yet only one therapeutic intervention is currently licensed for use in developed countries. Recent investigations of the transient cortical layer known as subplate, especially regarding subplate's secretory role, opens up a novel set of potential molecular modulators of neonatal HI injury. This review examines the biological mechanisms of human neonatal HI, discusses evidence for the relevance of subplate-secreted molecules to this condition, and evaluates available animal models. Neuroserpin, a neuronally released neuroprotective factor, is discussed as a case study for developing new potential pharmacological interventions for use post-ischaemic injury.

Infantile tuberous sclerosis changes in the brain: proton MR spectroscopy findings

A parietal hamartoma of a three-month-old boy with tuberous sclerosis was studied with magnetic resonance (MR) imaging, and proton MR spectroscopy. MR spectra were obtained with the single-voxel PRESS (point resolved spectroscopy; TR = 1500 ms, TE = 135 ms) sequence, in a 8 cc region of interest. Apparently low NAA/Cho (0.28), and NAA/Cr (0.37) ratios were noted in the hamartoma, that could suggest a neoplasm. The lesion and the surrounding brain tissue were studied again after seven months with spectroscopic imaging using the chemical shift sequence (TR = 1500 ms. TE = 40 ms). This study revealed apparently improved NAA/Cho (2.63), NAA/Cr (2.13) ratios in the hamartoma compared to the initial examination at three months of age, excluding the possibility of a neoplasm.

Neonatal brain tumors: a review

This article presents two cases of infants with brain tumors and reviews the literature pertinent to congenital and neonatal brain tumors. Information regarding epidemiology, presentation, prognosis, and clinical management are also addressed with specific regard to differences between neonatal and childhood brain tumors. An appeal is made to consider (1) coordination of the care of these children through pediatric multidisciplinary neuro-oncology programs; (2) enrollment, whenever possible, in clinical trials; and (3) submission of available tumor tissue to pediatric tumor banks to assure its availability to interested researchers.

Neonatal diagnosis of tuberous sclerosis

Intracranial tumors are rare in the neonatal period, and generally the most common histological types are astrocytoma, medulloblastoma, choroid plexus papilloma and neuroectodermal tumors. The early diagnosis of these tumors is often very difficult. The authors report a case of a full-term newborn who presented with opisthotonus. A subependymal mass was detected by cerebral ultrasonography, and when the child was 1 month of age depigmentations appeared on the trunk and on the right leg, confirming the suspicion of tuberous sclerosis. At 3 months of age the child suffered infantile spasm with hypsarrhythmia. The developmental delay, the marked progressive neurological deterioration and the daily seizures suggested surgical resection. Histologic studies showed a subependymal giant cell astrocytoma such as typically occurs in tuberous sclerosis.