Learning objectives
1.
To describe Out --> In approach in the evaluation of the child with seizures
2.
To illustrate the spectrum of cases and to describe the usefulness of this approach in making a specific and complete diagnosis.
3.
Case-based exhibit – Illustration of cases with specific teaching points.
Background
A seizure is a transient occurrence of signs or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.
Depending on the distribution of this discharges,
this abnormal brain activity can have various manifestations.
Epilepsy describes a condition in which a person has a risk of recurrent seizures due to chronic,
underlying process.
Pediatric group broadly includes neonates (<1 month),
infants and children (>1 month and <12 years) and adolescents (12-18 years).
Classification of seizures (1):
1.
Focal onset: Further described as having...
Findings and procedure details
Brain CT and MR studies ordered for evaluation of seizures were evaluated from 2014 to 2018,
All findings diagnosed with Out --> approach is represented with examples as follows
Neuroimaging (1):
MRI is the modality of choice for evaluation of seizures.
It is superior to CT due to its excellent inherent tissue characterization and spatial resolution.
Advanced MRI techniques spectroscopy,
DTI,
perfusion can also be performed.
CT brain imaging is used in the evaluation of cases of trauma or suspected tiny calcifications in MRI brain....
Conclusion
1.
This exhibit is mainly focussed to describe anapproach.
Only a few representative cases are illustrated with teaching points as part of the approach.
2.
Occam'sRazor - If lesions are seen in multiple categories of out --> in approach in a single case,
try to make a single diagnosis which would explain all lesions.
E.g.
if a patient has multiple lesions in the skin,
extra-axial dural lesion with focal calvarial thickening,
T2 hyperintense lesions in bilateral basal ganglia and lesion in CP angle extending to...
References
1.
Kasper,
D.,
Fauci,
A.,
Hauser,
S.,
Longo,
D.,
Jameson,
J.
and Loscalzo,
J.
(2018).Harrison's Principles of Internal Medicine.
20th ed.
New York: McGraw-Hill Professional Publishing,
pp.3050 - 3060.
2.
Raus I,
Coroiu RE,
Capusan CS.
Neuroimaging in pediatric phakomatoses.
An educational review.Clujul Med.
2016;89(1):56-64.
3.
Bronen,
R.,
Fulbright,
R.,
Spencer,
D.,
Spencer,
S.,
Kim,
J.
and Lange,
R.
(1995).
MR characteristics of neoplasms and vascular malformations associated with epilepsy.Magnetic Resonance Imaging,
13(8),
pp.1153-1162.
4.
Smirniotopoulos,
J.,
Murphy,
F.,
Rushing,
E.,
Rees,
J.
and Schroeder,...