Salmonella typhimurium meningitis in an exclusively breast fed infant: A case report

Salmonella-related meningitis brings greater morbidity and mortality than that caused by other bacteria. We report a case of Salmonella typhimurium meningitis in a male child aged 5½ months who presented with fever, poor feeding, and irritability. Anterior fontanelle was bulged. S. typhimurium was isolated from cerebrospinal fluid. Child was treated with intravenous antibiotics for 4 weeks and he recovered completely.

Conventional and advanced MR imaging findings in a cohort of pathology-proven dermoid cysts of the pediatric scalp and skull

Background In the pediatric population, dermoid cysts are among the most frequent lesions of the scalp and skull. Imaging plays a key role in characterizing scalp and skull lesions in order to narrow the differential diagnoses. In general, dermoids are described as heterogeneous T1-/T2-hypo- to hyperintense lesions on magnetic resonance imaging. Methods The goal of this retrospective study is to evaluate the diffusion weighted imaging findings while reviewing the conventional T1-/T2-/T1+C-weighted MR characteristics in a pathology-proven series of 14 dermoids of the pediatric scalp and skull. Results In our pediatric cohort (eight boys, six girls, age range 3–95 months), half of the dermoids were homogeneous T1-hypointense and homogeneous T2-hyperintense. We found a mixture of restricted (45.5%) and increased diffusion (54.5%) in dermoids. The vast majority of dermoids (91.7%) showed rim enhancement. Most dermoids (57.1%) were located at the midline and adjacent to one of its sutures. Conclusions This study suggests that dermoids may have more variable imaging appearances than hitherto assumed and are frequently seen in close proximity or adjacent to the anterior fontanelle.

Dermoid Cyst in the Anterior Fontanel: Case Report

Introduction: Dermoid cysts in the anterior fontanel are rare lesions, problems around 0.1–0.5% of all cranial tumors. It originated during the early stages of development and derived from embryonic epithelial tissue located along the midline. CT and NMR studies are of choice to rule out intracranial extension. They are diagnosed and treated with surgery in childhood. In this article, a review of the literature on this pathology is performed and a clinical case is reported in order to show the results of imaging studies in the Dermoid Cyst in childhood. Case Presentation: Four-month-old female infant with Dermoid Cyst in the Anterior Fontanelle, without neurological compromise who was once a surgery. The surgical piece affected uniform, encapsulated, mobile, soft lesion with clear content. The obstetric history, clinical data, physical examination, imaging and histopathological studies confirmed the diagnosis of Dermoid Cyst, the patient’s postoperative evolution is satisfactory, currently undergoing follow-up by Neuropediatrics. Conclusion: in simple pediatric patients with Dermoid Cyst in the anterior Fontanelle, simple Computerized Axial Skull Tomography is very useful for its diagnosis, as well as the performance of surgical treatment and postoperative follow- up for a favorable evolution and better prognosis. Keywords: dermoid cyst, anterior fontanelle, congenital inclusion cyst, case report. RESUMEN Introducción: La frecuencia de presentación del Quiste Dermoide en fontanela anterior es muy baja y se desarrollan en la etapa embrionaria de la vida en la que el tejido embrionario de la línea media dá lugar a su formación. Los estudios de TAC y RMN son de elección para descartar la extensión intracraneal. Se diagnostican y tratan con cirugía en la niñez. En este artículo se realiza una revisión de la literatura sobre esta patología y se relata un caso clínico con el objetivo de mostrar los resultados de estudios imagenológicos en el Quiste Dermoide en la infancia. Presentación de Caso: Lactante femenina de cuatro meses con Quiste Dermoide de la fontanela anterior sin complicaciones fue intervenida quirúrgicamente. Se realizó excéresis de lesión blanda, encapsulada y movible. Los antecedentes obstétricos, datos clínicos, examen físico, estudios imagenológicos e histopatológico confirmaron el diagnóstico de Quiste tipo Dermoide, la evolución posoperatoria de la paciente es satisfactoria, actualmente en seguimiento por Neuropediatría. Conclusiones: En pacientes pediátricos con Quiste Dermoide en la Fontanela anterior es de gran utilidad la Tomografía Axial Computarizada simple de Cráneo para su diagnóstico, así como, la realización de un tratamiento quirúrgico y el seguimiento postoperatorio para una favorable evolución y mejor pronóstico. Palabras clave: quiste dermoide, fontanela anterior, quiste de inclusión congénita, informe de caso.

Orexin A peptidergic system: Comparative physiology, morphology and population between brains of nomal and Alzheimer’s disease mice

Sleep disturbance is common in patients with Alzheimer’s disease (AD), and orexin A is a pivotal neurotransmitter for bidirectional regulating the amyloid-β (Aβ) deposition of AD brain and poor sleep. In the present study, we examined the characteristic of sleep-wake architecture in APPswe/PSldE9 (APP/PS1) and Aβ-treated mice using electroencephalogram (EEG) and electromyographic (EMG) analysis. We compared the expression of orexin A, distribution, and morphology of the corresponding orexin A neurons using innovative methods including three-dimensional reconstruction and brain tissue clearing between Wild type (WT) and APP/PS1 mice. Results from our study demonstrated that increased wakefulness and reduced NREM sleep were seen in APP/PS1 and Aβ treated mice while the expression of orexin A was significantly upregulated. Higher density and distribution of orexin A activated neurons were seen in APP/PS1 mice, with a location of 1.06 mm to 2.30 mm away from the anterior fontanelle compared to 1.34 mm to 2.18 mm away from the anterior fontanelle in WT mice. These results suggested that the population and distribution of orexin A may play an important role in the progression of AD.

Delayed Diagnosis of Congenital Hypothyroidism in a 6-month-old Male Infant in Tamale, Ghana.

Congenital hypothyroidism is a common inborn endocrine disorder. Asymptomatic presentation in majority of cases mean that its diagnosis may be missed especially in settings where newborn screening is absent. We present a case of delayed diagnosis of congenital hypothyroidism and emphasize on need for high level of suspicion to aid prompt diagnosis and treatment. Our case is a 3 year, 4 months old male, who was first seen at 5 months of age on account of poor growth. He passed meconium after day four of life, developed jaundice in first week of life, and slept a lot in neonatal period. He had coarse faces, protruding tongue, widened anterior fontanelle and herniation of umbilicus. He was started on oral levothyroxine 50 microgram daily. In resources limited settings where universal newborn screening is absent, healthcare workers should have a high level of suspicion in picking up the early signs of the condition.

Distant large acute epidural hematoma after closed cerebrospinal fluid tapping through the anterior fontanelle: A case report and its pathogenesis

Background: Cerebrospinal fluid (CSF) infection is one of the most common and serious complications of shunt placement. The CSF shunt infections are preferably treated with intravenous antibiotics, infected shunt removal, repeated tapping (infants) or placement of an external ventricular drainage (EVD) device, and placement of a new shunt once the CSF is sterile. The tapping through the anterior fontanelle is commonly used instead of the EVD in developing countries to manage CSF infection in open anterior fontanelle patients. To the best of our knowledge, this would be considered the first reported case of distant epidural hematoma after closed ventricular tapping. Case Description: We report a case of 6-months child with Chiari malformation (Type II) presenting to us with a shunt infection with possible obstruction. CSF was aspirated for examination through a tap through the anterior fontanelle followed by the development of extradural hemorrhage far from the tapping site. Conclusion: EDH after a transfontanellar ventricular tap can rapidly evolve and lead to patient death. This report raises the awareness of the neurosurgeons to this possible complication that can happen and leads to major complications. Monitoring the conscious level would be needed after ventricular tapping to detect this possible complication.

Transient bulging fontanelle following rotavirus vaccination: A case report

Transient bulging fontanelle is a self-limiting clinical condition characterized by a bulging fontanelle with or without fever, which resolves without medical intervention. It is a relatively uncommon adverse event following immunization. We report a case of an 11 week old, otherwise healthy male infant who presented with a bulging, nontense anterior fontanelle without fever, which developed 11 hours after receiving rotavirus vaccine. Transfontanelle ultrasound scan findings were essentially normal. Two days later, the bulging anterior fontanelle resolved spontaneously. The child had normal neurological development and achieved corresponding developmental milestones over the subsequent eight months of follow-up. This case report highlights the importance of immunization history in the otherwise healthy infant who presents with bulging fontanelle. We recommend that in an otherwise well recently vaccinated infant that presents with bulging anterior fontanelle, lumbar puncture should be deferred while the infant is closely monitored.