Neurodevelopmental Status in Children with Extraventricular Obstructive Hydrocephalus
CPS ePoster Library. Abu Kuwaik G. 06/25/15; 99258; 197
Dr. Ghassan Abu Kuwaik
Dr. Ghassan Abu Kuwaik
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Abstract
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Neurodevelopmental status of children with macrocephaly and Extraventricular Obstructive Hydrocephalus (EVOH)
EVOH is a relatively common neuroimaging finding in infants & young children who are investigated for macrocephaly. These children typically have non-progressive enlargement of ventricular and extra-axial subarachnoid spaces. Different terms have been used interchangeably many of which include in most the term “benign”. The association of developmental problems in some of these children begs the question as to whether or not this is indeed a “benign” condition. Literature concerning the clinical implications of these findings in the context of macrocephaly is scarce and controversial as diverging opinions exist regarding the neurodevelopmental outcome. The reported outcomes have ranged from normal to mild-moderate neurodevelopmental deficits including learning disabilities, speech problems as well as motor delay.
A retrospective study of children with macrocephaly and radiologically confirmed EVOH was performed by chart review completed by a developmental paediatrician and neuroimaging review by a pediatric neuroradiologist. 295 patient reports were identified and reviewed. 209 reports were excluded (93 had clear comorbid neurological, developmental and genetic condition, 73 were multiple reports on a single patient and duplicate entries, 22 were head ultrasound reports only,13 had no interpretable data, 8 had no documented neurodevelopmental clinic visit data). 86 children with macrocephaly and EVOH confirmed by head CT and/or MRI were eventually identified.
Neurodevelopmental status was established by neurodevelopmental examination conducted by a pediatric neurologist in the Neurodevelopmental Clinic. Eighty six children (67 male) with EVOH were identified.Twenty four (28%) had mild to moderate neuro-developmental deficits including: motor(gross & fine), communication, social and adaptive.Most of the children with neurodevelopmental deficits were males (23/24).Preliminary analysis revealed no significant association (p=0.467) between developmental deficits & the degree of ventriculomegaly or extra-axial CSF space enlargement. Nearly one-third of children with macrocephaly & EVOH have mild-moderate neurodevelopmental deficits, but there appear to be no neuroimaging findings that predict the presence of neurodevelopmental problems. Males with macrocephaly and EVOH appear to be particularly susceptible to developmental problems.
EVOH might not necessarily be “benign” in affected children. Children with EVOH merit close neurodevelopmental surveillance in order to institute timely developmental interventions for attainment of as normal a developmental trajectory as possible. The neurobiological mechanisms behind EVOH & the long term neurodevelopmental outcomes with standardized neurodevelopmental testing merits further prospective study.
Neurodevelopmental status of children with macrocephaly and Extraventricular Obstructive Hydrocephalus (EVOH)
EVOH is a relatively common neuroimaging finding in infants & young children who are investigated for macrocephaly. These children typically have non-progressive enlargement of ventricular and extra-axial subarachnoid spaces. Different terms have been used interchangeably many of which include in most the term “benign”. The association of developmental problems in some of these children begs the question as to whether or not this is indeed a “benign” condition. Literature concerning the clinical implications of these findings in the context of macrocephaly is scarce and controversial as diverging opinions exist regarding the neurodevelopmental outcome. The reported outcomes have ranged from normal to mild-moderate neurodevelopmental deficits including learning disabilities, speech problems as well as motor delay.
A retrospective study of children with macrocephaly and radiologically confirmed EVOH was performed by chart review completed by a developmental paediatrician and neuroimaging review by a pediatric neuroradiologist. 295 patient reports were identified and reviewed. 209 reports were excluded (93 had clear comorbid neurological, developmental and genetic condition, 73 were multiple reports on a single patient and duplicate entries, 22 were head ultrasound reports only,13 had no interpretable data, 8 had no documented neurodevelopmental clinic visit data). 86 children with macrocephaly and EVOH confirmed by head CT and/or MRI were eventually identified.
Neurodevelopmental status was established by neurodevelopmental examination conducted by a pediatric neurologist in the Neurodevelopmental Clinic. Eighty six children (67 male) with EVOH were identified.Twenty four (28%) had mild to moderate neuro-developmental deficits including: motor(gross & fine), communication, social and adaptive.Most of the children with neurodevelopmental deficits were males (23/24).Preliminary analysis revealed no significant association (p=0.467) between developmental deficits & the degree of ventriculomegaly or extra-axial CSF space enlargement. Nearly one-third of children with macrocephaly & EVOH have mild-moderate neurodevelopmental deficits, but there appear to be no neuroimaging findings that predict the presence of neurodevelopmental problems. Males with macrocephaly and EVOH appear to be particularly susceptible to developmental problems.
EVOH might not necessarily be “benign” in affected children. Children with EVOH merit close neurodevelopmental surveillance in order to institute timely developmental interventions for attainment of as normal a developmental trajectory as possible. The neurobiological mechanisms behind EVOH & the long term neurodevelopmental outcomes with standardized neurodevelopmental testing merits further prospective study.
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