Consensus statement on abusive head trauma in infants and young children

Abusive head trauma (AHT) is the leading cause of fatal head injuries in children younger than 2 years. A multidisciplinary team bases this diagnosis on history, physical examination, imaging and laboratory findings. Because the etiology of the injury is multifactorial (shaking, shaking and impact, impact, etc.) the current best and inclusive term is AHT. There is no controversy concerning the medical validity of the existence of AHT, with multiple components including subdural hematoma, intracranial and spinal changes, complex retinal hemorrhages, and rib and other fractures that are inconsistent with the provided mechanism of trauma. The workup must exclude medical diseases that can mimic AHT. However, the courtroom has become a forum for speculative theories that cannot be reconciled with generally accepted medical literature. There is no reliable medical evidence that the following processes are causative in the constellation of injuries of AHT: cerebral sinovenous thrombosis, hypoxic-ischemic injury, lumbar puncture or dysphagic choking/vomiting. There is no substantiation, at a time remote from birth, that an asymptomatic birth-related subdural hemorrhage can result in rebleeding and sudden collapse. Further, a diagnosis of AHT is a medical conclusion, not a legal determination of the intent of the perpetrator or a diagnosis of murder. We hope that this consensus document reduces confusion by recommending to judges and jurors the tools necessary to distinguish genuine evidence-based opinions of the relevant medical community from legal arguments or etiological speculations that are unwarranted by the clinical findings, medical evidence and evidence-based literature

Pediatric Demyelinating Disease: Emerging Patterns from Multiple Sclerosis to Anti-Myelin Oligodendrocyte Glycoprotein‐Associated Encephalomyelitis

Ongoing progress is being made in the understanding of pediatric demyelinating diseases, including the recent discovery of anti-myelin oligodendrocyte glycoprotein (anti-MOG) encephalitis. Radiologists play a key role in the diagnostic work-up of these patients. Demyelinating diseases can be challenging to differentiate from each other and can mimic anti-MOG encephalitis, especially because the various disorders can present with nonspecific radiologic cord findings and overlapping CNS features. There are some key imaging features that can be explained by the more recent development in the pathophysiological basis of these different entities. Attention to pertinent clinical history allows for improved diagnostic accuracy. Identifying MR imaging predictors of a particular demyelinating diagnosis in the pediatric population can have broad implications on treatment.</jats:p

Diffusion-weighted imaging using readout-segmented EPI reveals bony metastases from neuroblastoma

Identifying neuroblastoma (NBL) metastases is crucial to treatment and prognosis. Metaiodobenzylguanidine and Tc99M bone scans are standard for identifying bony metastases but can underestimate disease. Diffusion-weighted imaging (DWI) of the spine has shown promise in evaluating bony metastases but has been limited by artifacts. Readout-segmented echo planar imaging is a technique for DWI that minimizes artifacts allowing for improved identification of spinal disease. This report illustrates the utility of DWI of the spine using readout-segmented echo planar imaging in the detection of bony NBL metastases in a child, lending support that DWI should be included in magnetic resonance imaging scans for NBL

Diffusion-Weighted Imaging of the Pediatric Spine Using Readout-Segmented Echo Planar Imaging: A Pictorial Review of Clinical Applications

Diffusion-weighted imaging (DWI) promises to be a powerful tool for imaging the pediatric spine. Until now, DWI of the spine has not been clinically relevant due to poor image quality. A relatively new technique, readout-segmented EPI, is a multishot, diffusion-weighted sequence that segments the images in the readout direction, which allows images with higher spatial resolution and/or reduced distortion of the spine to be obtained. This is especially important when imaging children, and we found it to be helpful in the evaluation of numerous pathologic conditions of the pediatric spine, including tumors, infarction, infection, inflammatory and/or autoimmune diseases, and trauma. Once optimized and made more widely available, DWI may become the standard of care in MR imaging of the spine in children, just as DWI of the brain has become the standard over the past few decades. Learning Objective: To recognize the DWI findings on MR imaging of the spine in children with numerous pathologic spinal conditions, including tumor, infarction, and infection, that can be revealed with readout-segmented DWI

Neuroimaging manifestations in children with SARS-CoV-2 infection: a multinational, multicentre collaborative study.

Background: The CNS manifestations of COVID-19 in children have primarily been described in case reports, which limit the ability to appreciate the full spectrum of the disease in paediatric patients. We aimed to identify enough cases that could be evaluated in aggregate to better understand the neuroimaging manifestations of COVID-19 in the paediatric population. Methods: An international call for cases of children with encephalopathy related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and abnormal neuroimaging findings was made. Clinical history and associated plasma and cerebrospinal fluid data were requested. These data were reviewed by a central neuroradiology panel, a child neurologist, and a paediatric infectious diseases expert. The children were categorised on the basis of their time of probable exposure to SARS-CoV-2. In addition, cases were excluded when a direct link to SARS-CoV-2 infection could not be established or an established alternate diagnostic cause could be hypothesised. The accepted referral centre imaging data, from ten countries, were remotely reviewed by a central panel of five paediatric neuroradiologists and a consensus opinion obtained on the imaging findings. Findings: 38 children with neurological disease related to SARS-CoV-2 infection were identified from France (n=13), the UK (n=8), the USA (n=5), Brazil (n=4), Argentina (n=4), India (n=2), Peru (n=1), and Saudi Arabia (n=1). Recurring patterns of disease were identified, with neuroimaging abnormalities ranging from mild to severe. The most common imaging patterns were postinfectious immune-mediated acute disseminated encephalomyelitis-like changes of the brain (16 patients), myelitis (eight patients), and neural enhancement (13 patients). Cranial nerve enhancement could occur in the absence of corresponding neurological symptoms. Splenial lesions (seven patients) and myositis (four patients) were predominantly observed in children with multisystem inflammatory syndrome. Cerebrovascular complications in children were less common than in adults. Significant pre-existing conditions were absent and most children had favourable outcomes. However, fatal atypical CNS co-infections developed in four previously healthy children infected with SARS-CoV-2. Interpretation: Acute-phase and delayed-phase SARS-CoV-2-related CNS abnormalities are seen in children. Recurring patterns of disease and atypical neuroimaging manifestations can be found and should be recognised being as potentially due to SARS-CoV-2 infection as an underlying aetiological factor. Studies of paediatric specific cohorts are needed to better understand the effects of SARS-CoV-2 infection on the CNS at presentation and on long-term follow-up in children. Funding: American Society of Pediatric Neuroradiology, University of Manchester (Manchester, UK).</p

Genome Sequence of Streptomyces sp. Strain Tü6071▿

Streptomyces sp. Tü6071 is a soil-dwelling bacterium which has a highly active isoprenoid biosynthesis. Isoprenoids are important precursors for biopharmaceutical molecules such as antibiotics or anticancer agents, e.g., landomycin. Streptomyces sp. Tü6071 produces the industrially important terpene glycosides phenalinolactones, which have antibacterial activity against several Gram-positive bacteria. The availability of the genome sequence of Streptomyces sp. Tü6071 allows for understanding the biosynthesis of these pharmaceutical molecules and will facilitate rational genome modification to improve industrial use