A single-site retrospective study of pediatric arterial ischemic stroke etiology, clinical presentation, and radiologic features

Background Stroke occurs upon obstruction of cerebral blood circulation and is clinically characterized by sudden onset symptoms. Advanced age is the main risk factor of stroke, but cases of pediatric stroke have been rarely reported. This study aimed to determine the etiology, clinical presentation, and radiologic features of neurological deficit for pediatric arterial ischemic stroke （PALS）. Methods The medical records of 42 PAlS patients （age range： 9 months to 13 years） treated at Wuhan Children＇s Hospital between July 2007 and January 2011 were retrospectively reviewed. Infarction location was first determined by craniocerebral computed tomography and magnetic resonance （MR） imaging. The stenotic or occluded main cerebral arteries and/or branches were determined by MR angiography and digital subtraction angiography. Results The majority of the 42 PAlS cases （66.7%, n=28） were 〈3 years old （vs. 〉3 years old： 33.3%, n=14; P〈0.05）, but the male： female ratio was similar in both groups （P〉0.05）. The most frequently reported signs and symptoms for both age groups were limited physical activity followed by convulsions and delirium, but convulsions were more prevalent in children 〈3 years-old. Children〉3 years-old mainly experienced the limited physical activity symptoms, including hemiparalysis, aphasia, and ataxia. For all 42 cases, the most frequent etiologies were infections （38.1%, n=16）, iron deficiency anemia （16.7%, n=7）, and moyamoya syndrome （11.9%, n=5）. The predominant infarcts among all cases were middle cerebral artery （63.6%, n=21） and basal ganglia （64.3%, n=27）. Conclusions PAlS occurs more frequently in younger children and this group most frequently presents with convulsion as the initial symptom. The overall etiologies of PAlS may be different from those of adult stroke and the involved regions may be distinguishing features of PAlS or its different forms, but more research is required.

Ocular manifestations of intracranial germinomas： three cases report and literature review

Intracranial germinomas are malignant neoplasms of gonadal origin, which have some features in terms of age, sex, and clinical manifestations. They mainly occur in children and adolescents. Patients with intracranial germinomas mainly manifest with hypothalamic pituitary axis dysfunction and/or compression syndromes. Visual disturbance is one of the most Significant clinical presentations, which is mainly caused by tumor cell infiltration into the optic pathway. In this article, we present three cases of patient with intracranial germinoma to analyze the ocular manifestations. All the three patients presented with endocrine symptoms in the early stage and with visual disturbances （including decreased visual acuity and visual field defects） later. In general, germinoma is diagnosed by its characteristic radiological appearance, supported by tumor markers and/or stereotactic biopsy. However, decisive diagnoses were established when ocular manifestations were presented. A suspicion for germinoma should be considered, when young patients manifest visual disturbances accompanied by endocrine symptoms.

Pancreatic lymphangioma:two case reports from an institutional experience with a rare entity and review of literature

Pancreatic lymphangiomas are very rare benign cystic lesions that pose a diagnostic dilemma due to their resemblance to other non-neoplastic and neoplastic pancreatic cystic lesions.As such,pancreatic lymphangiomas are frequently diagnosed only after histological examination of the excised lesion.We present 2 cases of pancreatic lymphangioma,determine its prevalence at our institution and perform a detailed review of published literature since 2010.Case 1 is a 36-year-old male and case 2 is a 35-year-old female,both of which presented with abdominal pain.These were the only cases of pancreatic lymphangiomas reported at our institution since 2010.We reviewed 69 cases of pancreatic lymphangiomas from 52 publications.It affects predominantly females with a median age of 43 and such patients typically present with abdominal pain(58.8%)or are asymptomatic(27.9%).The median size is 8.6 cm,the most common location is the head of pancreas and the most common imaging finding is that of a multilocular cyst.Majority of patients underwent surgical resection(69.6%).Endoscopic ultrasound-guided fine-needle aspiration features of pancreatic lymphangiomas include chylous cyst fluid,elevated fluid triglyceride levels(15/16 cases)and numerous lymphocytes on cytology.The majority of patients with elevated fluid triglyceride levels(13/15 cases)were managed conservatively.Pancreatic lymphangiomas are rare pancreatic cystic lesions that may be diagnosed preoperatively using a multidisciplinary and multimodal approach involving clinical,radiological,biochemical and cytological features,allowing greater confidence in the selection of patients who can be managed conservatively.