Complications de la neurofibromatose de type 1 chez l'enfant : à propos d'une série de 100 cas

Neurofibromatosis 1 (NF1) is a frequent genetic disease. Diagnostic criterias were established in 1988. The patients can exhibit various and unpredictable complications.

OBJECTIVES

To check the efficiency of a coordinated follow-up in specialized multidisciplinary centers providing a higher quality of management and to have a better knowledge of the complications including their true frequencies.

POPULATION AND METHODS

We report a serie of 100 NF1 children who were followed-up during 4 years in a specialized center at the Tours University Hospital. Three hospital check-up at 2-5, 6-7, 14-15 years of age were performed as well as an annual physical examination.

RESULTS

In our serie, the mean age was 7.8 years old with a sex ratio of 1. The mean age at diagnosis was 3.8 years old and the main diagnosis criteria were the café-au-lait spots and the family history for 80% of the patients. The optic nerve glioma has a low frequency of 5%. Learning disabilities clearly represent the most frequent complication (46% of the patients).

CONCLUSION

An early detection of these difficulties is a priority for the appropriate management of these children.

[Hydrocephalus during pregnancy with or without neurosurgical history in childhood. Practical advice for management]

Many women with cerebrospinal fluid shunts are now reaching reproductive age. Clinical management of pregnant patients with hydrocephalus should include preconception counseling and CT scan or MRI. A family pedigree should also be established for counseling on the risk of recurrence of the woman's condition or another neural tube defect. Electrophoresis of acetylcholinesterase in the amniotic fluid can provide the diagnosis of open neural tube defect between 13 and 24 weeks gestation. Shunt malfunction may occur during pregnancy in 50 % of cases. Management requires well-planned, a combined neurosurgical and obstetrical approach. Vaginal delivery is possible in asymptomatic mothers. Cesarean section is recommended for neurologically unstable patients. Prophylactic antibiotics are recommended for labor and delivery to avoid shunt infection. Epidural analgesia is contraindicated in patients with intracranial hypertension. Some complications of complementary treatment for cerebral tumors in childhood are briefly reported.

[Prenatal diagnosis of anomalies of the corpus callosum with ultrasound: the echographist's point of view]

Ultrasonography can identify agenesis of the corpus callosum (excluding holoprosencephaly which an be detected earlier on) in the second trimester of pregnancy (18-20 weeks gestation). Diagnosis of corpus callosum agenesis is difficult but is important as a risk factor for neurological or genetic malformations. The characteristic signs suggestive of corpus callosum agenesis are: moderate distension of the occipital ventricle and the ventricular communications; absence of the spectrum giving rise to an upward displacement of the third ventricle shown in the anterior coronal section (especially in transvaginal ultrasonography); radial position of the fissures on the internal side of the cerebral hemisphere seen on the sagittal section; the absence in color coded Doppler of the pericallosal artery normally characterised by a semicircular vessel observable on the median sagittal section. At present, color coded Doppler should give the diagnosis of corpus callosum agenesis. MRI can provide further information especially in case of late detection around 28-30 weeks gestation as is most frequently the case. The development of 3D echographic imaging should allow an even more sophisticated approach to this diagnosis giving even more precise prognosis. Isolated corpus callosum agenesis is compatible with normal intellectual development an raises an important problem with regard to pregnancy continuation and infant development. Each individual case should be discussed during the pluridisciplinary prenatal diagnostic discussion.

[Post-traumatic transient cortical blindness]

BACKGROUND

Transient cortical blindness is a rare complication of mild head trauma in children. This spectacular manifestation always has a benign outcome.

CASE REPORT

A five-year-old girl was admitted for bilateral blindness immediately following a fall with frontal head injury. Neurological examinations and ophthalmological investigations showed no abnormalities. The electroencephalogram showed slow waves in the left occipital area. The blindness resolved completely within 3 hours.

CONCLUSION

This bilateral blindness was similar to that of the 40 cases reported since 1964, including a rapid and benign outcome. Its mechanism is not clear, although some suggest a cerebral vasospasm. Our patient's mother has a history of migraine.