Follow-up study of macrocephalic children with enlargement of the subarachnoid space

Gherpelli, J. L. D.; Scaramuzzi, V.; Manreza, M. L. G.; Diament, A.J.

doi:10.1590/S0004-282X1992000200004

Abstracts

Eighteen macrocephalic children with enlargement of the subarachnoid space (ESAS), with or without mild ventricular dilatation, were followed prospectively to a mean age of 56 months. All were born at term, with uneventful neonatal period and negative tests for congenital infections. There were 17 boys and 1 girl and the mean follow-up period was 46 months (8-58 months). The initial neurologic evaluation, between ages of 2 to 33 months, disclosed abnormalities in 2 cases. At the follow-up one was still abnormal and the other had a normal neurological examination. Another child, who had a normal neurological examination at the age of 5 months, at the age of 7 years and 7 months had an IQ of 77. Thus the abnormality rate at follow-up was 11%. The OFC returned to the normal range in 45% of the children at the follow-up period. There were no cases of intracranial hypertension. One infant had subdural taps performed at the age of 13 months that disclosed a fluid with the same characteristics as the CSF. All the children had a CT-scan performed at the beginning of the study that revealed a large subarachnoid space; in 77% it was associated with mild ventricular dilatation. Eleven had CT-scans repeated, during the study period, which showed resolution of the process in 3 cases, improvement in 2, and unchanged in 6. We conclude that enlargement of the subarachnoid space in macrocephalic children is often a benign entity. ESAS and macrocephaly will still be present in the majority of children in the long-term follow-up.

macrocephaly; subarachnoid space; hydrocephalus

Trata-se de estudo prospectivo de 18 crianças com macrocefalia por aumento do espaço sub-aracnóideo, com ou sem dilatação ventricular, seguidas até idade em média de 56 meses. Todas nasceram a termo, sem intercorrências perinatais e com testes negativos para TORCH. O tempo médio de seguimento foi 46 meses. Havia 17 meninos e apenas uma menina no grupo estudado. A porcentagem de anormalidades neurológicas no seguimento foi de 11%. Durante o seguimento, o perímetro cefálico retornou aos níveis da normalidade em 45% das crianças. Nenhum caso desenvolveu hipertensão intracraniana durante o estudo. Todas as crianças realizaram TAC de crânio como parte da avaliação inicial e, além do aumento do espaço sub-aracnóideo peri-encefálico, 77% delas apresentavam discreta dilatação ventricular. No seguimento, 11 realizaram TAC de controle que revelaram resolução completa do processo em 3 casos, melhora em 2 e permaneceram inalteradas em 6. Concluimos que o aumento do espaço sub-aracnóideo em crianças macrocefálicas é entidade que apresenta bom prognóstico neurológico na maioria dos casos e que a macrocefalia e o aumento do sub-aracnóideo continuarão presentes, na maioria das crianças, no seguimento a longo prazo.

macrocefalia; espaço sub-aracnóideo; hidrocefalia

J. L. D. Gherpelli; V. Scaramuzzi; M. L. G. Manreza; A.J. Diament

Division of Child Neurology, Department of Neurology, Clinics Hospital, University of Sao Paulo Medical School

SUMMARY

Eighteen macrocephalic children with enlargement of the subarachnoid space (ESAS), with or without mild ventricular dilatation, were followed prospectively to a mean age of 56 months. All were born at term, with uneventful neonatal period and negative tests for congenital infections. There were 17 boys and 1 girl and the mean follow-up period was 46 months (8-58 months). The initial neurologic evaluation, between ages of 2 to 33 months, disclosed abnormalities in 2 cases. At the follow-up one was still abnormal and the other had a normal neurological examination. Another child, who had a normal neurological examination at the age of 5 months, at the age of 7 years and 7 months had an IQ of 77. Thus the abnormality rate at follow-up was 11%. The OFC returned to the normal range in 45% of the children at the follow-up period. There were no cases of intracranial hypertension. One infant had subdural taps performed at the age of 13 months that disclosed a fluid with the same characteristics as the CSF. All the children had a CT-scan performed at the beginning of the study that revealed a large subarachnoid space; in 77% it was associated with mild ventricular dilatation. Eleven had CT-scans repeated, during the study period, which showed resolution of the process in 3 cases, improvement in 2, and unchanged in 6. We conclude that enlargement of the subarachnoid space in macrocephalic children is often a benign entity. ESAS and macrocephaly will still be present in the majority of children in the long-term follow-up.

Key words: macrocephaly, subarachnoid space, hydrocephalus.

RESUMO

Trata-se de estudo prospectivo de 18 crianças com macrocefalia por aumento do espaço sub-aracnóideo, com ou sem dilatação ventricular, seguidas até idade em média de 56 meses. Todas nasceram a termo, sem intercorrências perinatais e com testes negativos para TORCH. O tempo médio de seguimento foi 46 meses. Havia 17 meninos e apenas uma menina no grupo estudado. A porcentagem de anormalidades neurológicas no seguimento foi de 11%. Durante o seguimento, o perímetro cefálico retornou aos níveis da normalidade em 45% das crianças. Nenhum caso desenvolveu hipertensão intracraniana durante o estudo. Todas as crianças realizaram TAC de crânio como parte da avaliação inicial e, além do aumento do espaço sub-aracnóideo peri-encefálico, 77% delas apresentavam discreta dilatação ventricular. No seguimento, 11 realizaram TAC de controle que revelaram resolução completa do processo em 3 casos, melhora em 2 e permaneceram inalteradas em 6. Concluimos que o aumento do espaço sub-aracnóideo em crianças macrocefálicas é entidade que apresenta bom prognóstico neurológico na maioria dos casos e que a macrocefalia e o aumento do sub-aracnóideo continuarão presentes, na maioria das crianças, no seguimento a longo prazo.

Palavras-chave: macrocefalia, espaço sub-aracnóideo, hidrocefalia.

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Full text available only in PDF format.

Acknowledgements We would like to thank the Psychological Division (Beatriz H.W. Lefèvre) for the assistance in the psychological evaluation of the children.

REFERENCES

1. Briner S, Bodensteiner J. Benign subdural collections of infancy. Pediatrics 1981, 67:802-804.

2. Carolan PL, McLaurin RL, Towbin RB, Towbin JA, Egelhof FJC. Benign extra-axial collections of infancy. Pediat Neurosci 1985-86, 12:140-144.

3. De Vries LS, Smet M, Ceulemans B, Marchai G, Wilms G, de Roo M, Plets C, Casaer P. The role of high resolution ultrasound and MRI in the investigation of infants with macrocephaly. Neuropediatrics 1990, 21:72-75.

4. Fukuyama Y, Miyao M, Ishizu T, Maruyama H. Developmental changes in normal measurements by computed tomography. Dev Med Child Neurol 1979, 21:425-432.

5. Gooskens RHJM, Willemse J, Faber JA, Verdonck FMM. Macrocephalies: a differentiated approach. Neuropediatrics 1989, 20:1644-169.

6. Hamza M, Bodensteiner JB, Noorani PA, Barnes PD. Benign extracerebral fluid collections: a cause of macrocrania in infancy. Pediat Neurol 1987, 3:218-221.

7. Marcondes E. Normas para o diagnóstico e a classificação dos distúrbios de crescimento e nutrição. Pediatria (São Paulo) 1982, 4:307-326.

8. Ment LR, Duncan CC, Geehr R. Benign enlargement of the subarachnoid spaces in the infant. J Neurosurg 1981, 54:504-508. 9. Nellhaus G. Composite international and interracial graphs. Pediatrics 1968, 41:106-118.

10. Nickel RE, Gallenstein JS. Developmental prognosis for infants with benign enlargement of the subarachnoid spaces. Dev Med Child Neurol 1987, 29:181-186.

11. Pettit RE, Kilroy AW, Allen JH. Macrocephaly with head growth parallel to normal growth pattern. Arch Neurol 1980, 37:518-521.

12. Robertson WC, Gomez MR. External hydrocephalus: early finding in congenital communicating hydrocephalus. Arch Neurol 1978, 35:541-544.

13. Sahar A. Pseudohydrocephalus-megalencephaly, increased intracranial pressure and widened subarachnoid space. Neuropaediatrie 1978, 9:131-139.

Dr. José Luiz Dias Gherpelli Serviço de Neurologia Infantil, Departamento de Neurologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - Caixa Postal 3461 - 01060 São Paulo SP - Brasil.

1. Briner S, Bodensteiner J. Benign subdural collections of infancy. Pediatrics 1981, 67:802-804.
2. Carolan PL, McLaurin RL, Towbin RB, Towbin JA, Egelhof FJC. Benign extra-axial collections of infancy. Pediat Neurosci 1985-86, 12:140-144.
3. De Vries LS, Smet M, Ceulemans B, Marchai G, Wilms G, de Roo M, Plets C, Casaer P. The role of high resolution ultrasound and MRI in the investigation of infants with macrocephaly. Neuropediatrics 1990, 21:72-75.
4. Fukuyama Y, Miyao M, Ishizu T, Maruyama H. Developmental changes in normal measurements by computed tomography. Dev Med Child Neurol 1979, 21:425-432.
5. Gooskens RHJM, Willemse J, Faber JA, Verdonck FMM. Macrocephalies: a differentiated approach. Neuropediatrics 1989, 20:1644-169.
6. Hamza M, Bodensteiner JB, Noorani PA, Barnes PD. Benign extracerebral fluid collections: a cause of macrocrania in infancy. Pediat Neurol 1987, 3:218-221.
7. Marcondes E. Normas para o diagnóstico e a classificação dos distúrbios de crescimento e nutrição. Pediatria (São Paulo) 1982, 4:307-326.
8. Ment LR, Duncan CC, Geehr R. Benign enlargement of the subarachnoid spaces in the infant. J Neurosurg 1981, 54:504-508.
9. Nellhaus G. Composite international and interracial graphs. Pediatrics 1968, 41:106-118.
10. Nickel RE, Gallenstein JS. Developmental prognosis for infants with benign enlargement of the subarachnoid spaces. Dev Med Child Neurol 1987, 29:181-186.
11. Pettit RE, Kilroy AW, Allen JH. Macrocephaly with head growth parallel to normal growth pattern. Arch Neurol 1980, 37:518-521.
12. Robertson WC, Gomez MR. External hydrocephalus: early finding in congenital communicating hydrocephalus. Arch Neurol 1978, 35:541-544.
13. Sahar A. Pseudohydrocephalus-megalencephaly, increased intracranial pressure and widened subarachnoid space. Neuropaediatrie 1978, 9:131-139.

Follow-up study of macrocephalic children with enlargement of the subarachnoid space

Estudo evolutivo de crianças macrocefálicas com alargamento do espaço sub-aracnóideo

Publication Dates

Publication in this collection
22 Feb 2011
Date of issue
June 1992

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Briner S, Bodensteiner J. Benign subdural collections of infancy. Pediatrics 1981, 67:802-804.

[2] 2. Carolan PL, McLaurin RL, Towbin RB, Towbin JA, Egelhof FJC. Benign extra-axial collections of infancy. Pediat Neurosci 1985-86, 12:140-144.

[3] 3. De Vries LS, Smet M, Ceulemans B, Marchai G, Wilms G, de Roo M, Plets C, Casaer P. The role of high resolution ultrasound and MRI in the investigation of infants with macrocephaly. Neuropediatrics 1990, 21:72-75.

[4] 4. Fukuyama Y, Miyao M, Ishizu T, Maruyama H. Developmental changes in normal measurements by computed tomography. Dev Med Child Neurol 1979, 21:425-432.

[5] 5. Gooskens RHJM, Willemse J, Faber JA, Verdonck FMM. Macrocephalies: a differentiated approach. Neuropediatrics 1989, 20:1644-169.

[6] 6. Hamza M, Bodensteiner JB, Noorani PA, Barnes PD. Benign extracerebral fluid collections: a cause of macrocrania in infancy. Pediat Neurol 1987, 3:218-221.

[7] 7. Marcondes E. Normas para o diagnóstico e a classificação dos distúrbios de crescimento e nutrição. Pediatria (São Paulo) 1982, 4:307-326.

[8] 8. Ment LR, Duncan CC, Geehr R. Benign enlargement of the subarachnoid spaces in the infant. J Neurosurg 1981, 54:504-508.

[9] 9. Nellhaus G. Composite international and interracial graphs. Pediatrics 1968, 41:106-118.

[10] 10. Nickel RE, Gallenstein JS. Developmental prognosis for infants with benign enlargement of the subarachnoid spaces. Dev Med Child Neurol 1987, 29:181-186.

[11] 11. Pettit RE, Kilroy AW, Allen JH. Macrocephaly with head growth parallel to normal growth pattern. Arch Neurol 1980, 37:518-521.

[12] 12. Robertson WC, Gomez MR. External hydrocephalus: early finding in congenital communicating hydrocephalus. Arch Neurol 1978, 35:541-544.

[13] 13. Sahar A. Pseudohydrocephalus-megalencephaly, increased intracranial pressure and widened subarachnoid space. Neuropaediatrie 1978, 9:131-139.