General pediatrics

Sleep disorders and sleep complaints are common in the neurology patient. A good history can often be started with just a few well-worded questions to help identify the major sleep disorders. Identifying sleep-related disorders can help the neurologist broaden the differential diagnosis and treat disorders that can contribute significantly to many comorbidities of other neurologic diseases.

Laboratory testing to help determine the cause of a peripheral neuropathy can be challenging. A rational approach, as opposed to a shotgun approach, is advocated for efficiency and expense. The author reviews a spectrum of tests and provides a basis for when to order and not to order.

Inflammatory neuropathies are acquired disorders of peripheral nerves and occasionally of the central nervous system that can affect individuals at any age. The course can be monophasic, relapsing, or progressive. Inflammatory neuropathies are classified as acute or chronic. The acute form reaches a nadir by 4 weeks and the chronic form over 8 weeks or greater. The most common example of an acute inflammatory neuropathy is acute inflammatory demyelinating polyradiculoneuropathy (AIDP), which is part of the Guillain-Barré syndrome (GBS)...

The author reviews current treatment approaches for the management of acute immune-mediated peripheral neuropathies, including the Guillain-Barré syndrome together with the clinical variants, which are acute inflammatory demyelinating polyradiculoneuropathy, acute motor axonal neuropathy, acute motor and sensory axonal neuropathy, and the Fisher syndrome. A summary of clinical evidence for drug therapies is provided, with additional recommendations for commonly used treatment modalities including a focus on the approach to using intravenous immune globulin and plasma exchange therapy...

Rates of obesity and insulin resistance have climbed sharply over the past 30 years. These epidemics are temporally related to a dramatic rise in consumption of fast food; until recently, it was not known whether the fast food was driving the obesity, or vice versa. We review the unique properties of fast food that make it the ideal obesigenic foodstuff, and elucidate the mechanisms by which fast food intake contributes to obesity, emphasizing its effects on energy metabolism and on the central regulation of appetite...

Using social media Web sites is among the most common activity of today's children and adolescents. Any Web site that allows social interaction is considered a social media site, including social networking sites such as Facebook, MySpace, and Twitter; gaming sites and virtual worlds such as Club Penguin, Second Life, and the Sims; video sites such as YouTube; and blogs. Such sites offer today's youth a portal for entertainment and communication and have grown exponentially in recent years. For this reason, it is important that parents become aware of the nature of social media sites, given that not all of them are healthy environments for children and adolescents...

IMPORTANCE: Infantile colic is a common cause of inconsolable crying during the first months of life and has been thought to be a pain syndrome. Migraine is a common cause of headache pain in childhood. Whether there is an association between these 2 types of pain in unknown. OBJECTIVE: To investigate a possible association between infantile colic and migraines in childhood. DESIGN, SETTING, AND PARTICIPANTS: A case-control study of 208 consecutive children aged 6 to 18 years presenting to the emergency department and diagnosed as having migraines in 3 European tertiary care hospitals between April 2012 and June 2012...

BACKGROUND: The differential diagnosis of disorders of consciousness is challenging. The rate of misdiagnosis is approximately 40%, and new methods are required to complement bedside testing, particularly if the patient's capacity to show behavioral signs of awareness is diminished. METHODS: At two major referral centers in Cambridge, United Kingdom, and Liege, Belgium, we performed a study involving 54 patients with disorders of consciousness. We used functional magnetic resonance imaging (MRI) to assess each patient's ability to generate willful, neuroanatomically specific, blood-oxygenation-level-dependent responses during two established mental-imagery tasks...

Common variable immunodeficiency (CVID) is the most common clinically significant primary immune defect. Although the hallmark of CVID is hypogammaglobulinemia, the intrinsic dysregulation of the immune system leads to defective T-cell activation and proliferation, as well as dendritic cell and cytokine defects. Although 70% to 80% of patients have had recurrent sinopulmonary infections, autoimmunity and inflammatory complications are also common. The most common autoimmune conditions are immune thrombocytopenic purpura and hemolytic anemia, but other autoimmune complications arise, including rheumatoid arthritis, pernicious anemia, primary biliary cirrhosis, thyroiditis, sicca syndrome, systemic lupus, and inflammatory bowel disease...

In 1999, the American Academy of Pediatrics (AAP) issued a policy statement addressing media use in children. The purpose of that statement was to educate parents about the effects that media--both the amount and the content--may have on children. In one part of that statement, the AAP recommended that "pediatricians should urge parents to avoid television viewing for children under the age of two years." The wording of the policy specifically discouraged media use in this age group, although it is frequently misquoted by media outlets as no media exposure in this age group...

PURPOSE: Febrile seizures are induced by fever and are the most common type of seizures in children. Although numerous studies have been performed on febrile seizures, their pathophysiology remains unclear. Recent studies have shown that cytokines may play a role in the pathogenesis of febrile seizures. The present study was conducted to identify potential links between serum interleukin-1beta (IL-1β), tumor necrosis factor-alpha (TNF-α), and febrile seizures. METHODS: Ninety-two patients with simple or complex febrile seizures (46 patients per seizure type), and 46 controls with comparable age, sex, and severity of temperature were enrolled...

An otherwise healthy 6-year-old boy presented to the emergency department with a 2-year history of what his mother referred to as "eye problems." She reported noticing "whitish specks" surrounding both irises, which had been increasing in size. The boy was active and did not have any signs of..

A 12-year-old girl presented with a lump situated high in her neck at the midline (Panel A). She had previously been found to have hypothyroidism and had been treated with levothyroxine. There were no signs of infection. An ultrasonogram showed a solid midline mass. A technetium-99 thyroid scan..

A healthy 5-year-old boy presented with a 3-month history of an inflammatory mass on the scalp that had not responded to antibiotics. The physical examination revealed a boggy occipital swelling studded with pustules, as well as postauricular lymphadenopathy (arrow). The boy had no other symptoms,..

An 18-year-old woman presented with color and temperature changes in her hands, as well as intermittent tremor of the hands since the age of 15 years. She also reported involuntary right arm movements and difficulties with concentration. Physical examination of the eyes revealed bilateral..

A 3-year-old girl presented with a 3-week history of low back pain. Physical examination revealed mild tenderness over the upper lumbar spine. Lateral radiographs showed a moderate collapse of the first lumbar vertebra (Panel A, arrow). The results of a complete blood count, complete metabolic..

A 6-year-old girl who was born with a plaque on her forehead presented to the clinic. The plaque was smooth, elevated, and arranged in a linear pattern on the forehead. It then gradually grew down along the facial midline, conforming to Blaschko's lines. Neurologic and cardiac examinations were..

A 2-year-old boy underwent abdominal magnetic resonance imaging (MRI) after liver transplantation. The patient had been born prematurely at a gestational age of 24 weeks 5 days. At 18 months of age, abdominal fullness developed. At that time, an ultrasound examination showed a hepatic mass, and..

A 1-year-old boy presented with a 3-day history of intermittent fever, barking cough, and hoarseness. The physical examination revealed neck lymphadenopathy and audible stridor, but the patient was not in respiratory distress and was not drooling. An oropharyngeal examination did not detect any..

A 2-year-old girl was referred for an abnormal whitening (leukocoria) of the left pupil, as well as a divergent squint (Panel A). Her visual acuity was markedly impaired. Ophthalmologic examination revealed retinal detachment. Computed tomography showed left intraocular calcification (Panel B,..