A 6-year-old female presented with right hemichorea, initially thought to be post-streptococcal, which subsequently progressed to a right dystonic hemiplegia. At 7½ years she developed right focal and secondary generalized tonic–clonic seizures. These became intractable. A brain biopsy was consistent with Rasmussen's encephalitis (RE). At 9½ years the child underwent a left hemispherectomy making a good recovery with resolution of seizures. At 12 years she presented with recurrent episodes of abdominal pain, fever, and malar rash with serological evidence of systemic lupus erythematosus (SLE). A possible link between RE and SLE is discussed.

Subdural hemorrhage (SDH) detected postnatally in the newborn infant is usually related to trauma at the time of vaginal delivery. With improvement in obstetric methods, the incidence of this problem has declined. However, with advances in obstetric ultrasonography, it has been recognized that SDH may occur in utero before the onset of delivery. Intrauterine SDH remains a rare event. A review of the literature revealed only 32 cases to date (Tables I and II). Neonatal SDH is venous in origin and associated with trauma in most cases. Etiopathogenesis of neonatal SDH is explained by shearing of bridging veins or other venous structures caused by trauma. Instrumental delivery (forceps or vacuum extraction) causes distortion of the infant's cranium with elongation of the falx and angulation of the tentorium, leading to tearing of posterior fossa venous structures and bleeding into the subdural space. Rupture or tearing of large venous channels, such as the great vein of Galen, straight or transverse sinus or falx laceration with rupture of the sagittal sinus, result in accumulation of blood in both the supratentorial and infratentorial compartments. However, etiopathogenesis of intrauterine SDH is less certain. The fetus is usually well protected from direct abdominal trauma by maternal structures and amniotic fluid. Fetal intracranial vessels may be susceptible to shearing or acceleration/deceleration forces because of the following features: first, the head is large and neck muscles weak; this allows more rotational movement with angular acceleration. Second, the subarachnoid space is larger, allowing the brain to move within the cranium easily. Third, the fetal brain has a higher water content that increases its mass and allows it to develop more momentum when acceleration is applied. These unique conditions could make the fetus more susceptible to developing subdural hematomas and allow the development of subdural hematomas without obvious trauma.

We conducted a double-blind placebo study to investigate the claim that hyperbaric oxygen treatment (HBO2) improves the cognitive status of children with cerebral palsy (CP). Of 111 children diagnosed with CP (aged 4 to 12 years), only 75 were suitable for neuropsychological testing, assessing attention, working memory, processing speed, and psychosocial functioning. The children received 40 sessions of HBO2 or sham treatment over a 2-month period. Children in the active treatment group were exposed for 1 hour to 100% oxygen at 1.75 atmospheres absolute (ATA), whereas those in the sham group received only air at 1.3 ATA. Children in both groups showed better self-control and significant improvements in auditory attention and visual working memory compared with the baseline. However, no statistical difference was found between the two treatments. Furthermore, the sham group improved significantly on eight dimensions of the Conners' Parent Rating Scale, whereas the active treatment group improved only on one dimension. Most of these positive changes persisted for 3 months. No improvements were observed in either group for verbal span, visual attention, or processing speed.

A female child presenting with acute flaccid paraparesis at 18 months was found to have a dermal sinus in combination with a dermoid cyst and a myxopapillary ependymoma of the cauda equina and conus medullaris. A possible embryologic relation between these lesions is discussed.

Animal studies suggest that psychological factors may interfere with the development of brain asymmetry during gestation. We evaluated whether psychological exposure in pregnancy was associated with mixed-handedness in the offspring. In a follow-up design study, 824 Danish-speaking women with singleton pregnancies provided information on psychological distress and the occurrence of life events in the early second and third trimesters of pregnancy. Handedness of the children was based on maternal reports when the children were 3 years of age. Among the 419 males and 405 females, 7% and 5% respectively were mixed-handed whereas mixed-handedness was found in 3% of the parents. Psychological distress in the third trimester as well as higher levels of stressful life events were related to a higher prevalence of mixed-handedness in the offspring. About 16% of the women reported more than one life event in the third trimester of pregnancy and among the offspring of these women 11% were mixed-handed(odds ratio=2.3; 95% confidence interval 1.2 to 4.4). Women who at the same time reported a high level of distress and stressful life events, had a three- to four-fold higher prevalence of mixed-handedness in their offspring.

Children with attention-deficit–hyperactivity disorder (ADHD) have difficulties with motor control, inhibition of motor responses, motor flexibility, and motor preparedness. We proposed that motor abnormalities in ADHD might result, at least in part, from an abnormal neuronal oscillatory mechanism necessary for motor temporal regulation. The aim of this study was to assess pacing in children with ADHD, by testing for rhythmic abnormalities of motor activity using a tapping test. Twenty-seven children (21 males, six females; aged 6 to 14 years 6 months; mean age 11 years 4 months, SD 2 years 2 months) diagnosed with ADHD according to DSM-IV clinical criteria, and 33 controls (25 males, eight females; aged 6 to 14 years 6 months; mean 11 years 1 month, SD 2 years 2 months), underwent a finger-tapping test requiring rhythmic responses to frequencies from 1 to 6Hz. All participants who were treated on a daily basis with methylphenidate (n=22) were medication-free on the day of the test. Most of the children with ADHD responded at a constant rate regardless of stimulus frequency, a phenomenon only seen in a small number of the controls. This specific error pattern, also seen in Parkinson's disease, has been attributed to an abnormal oscillatory mechanism mediated by dopaminergic fronto-striatal circuitry, which might also be pathophysiologically relevant for ADHD.

Terminology means ‘a set of words used in a specially understood or defined sense’. From the standpoint of an international journal welcoming English language material from all over the world, it is apparent that widespread differences in meaning and uses of terminology exist in the field of developmental medicine. Differences in terminology matter, as Bax and Mac Keith commented, ‘First, foremost, surely, is how careful we must be in our language. If words are used... (that) confuse us they may in fact harm the patient’.

Neuroborreliosis is an infection of the nervous system caused by the spirochete Borrelia burgdorferi, from which patients most commonly develop lymphocytic meningitis, radiculoneuritis, or cranial neuropathy. In this report a 9-year-old male with an unusual neurological complication of neuroborreliosis – benign intracranial hypertension (BIH) – is described. Clinical symptoms of BIH, which consist of increased CSF pressure in the absence of an intracranial mass or obstruction to the circulation of CSF, resolved completely after antibiotic therapy with ceftriaxone.