By Pierre Lasjaunias M.D., Ph.D. (auth.)
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Extra resources for Vascular Diseases in Neonates, Infants and Children: Interventional Neuroradiology Management
3. Melting-brain syndrome Aetiology Antenatal Neonatal Early infancy VGAM DAVS PAVM ++' + +++ ++b + +++ ++c Late infancy + +++ Cumulative negative factors include the following: no cavernous sinus opening of cerebral venous drainage; pial vein congestion or decreased venous flow with hydrodynamic disorders; progressive sinus stenosis and secondary thrombosis; venodural sinus junction incompetence with or without raised intrasinusal press ure and pial vein reflux. VGAM, vein of Galen aneurysmal malformation; DAVS, dural arteriovenous shunt; PAVM, pial arteriovenous malformation; +++, very frequent; ++, frequent; +, possible; -, not seen .
6. 7. 8. Modified Adelaide Pediatric Glasgow Coma Scale (Simpson 1991) Score Eye opening 6 5 4 Spontaneous 3 To speech 2 To pain None Verbal response Orientated (smiles) Words (can be consoled when crying) Vocal sounds (inconsistent, consolable) Cries (not consolable, irritable, restless) None Motor response Carrying out of commands Localisation of pain Withdrawal from pain Abnormal flexion to pain (decortication) Extension to pain (decerebration) None Modified from the Children Coma Scale (CCS), derived from the Glasgow Comas Scale by Hahn (1988).
Thus two high-ftow lesions both apparently located on the surface of the brain may have different effects on the underlying cerebral tissue depending on whether they open directly into subpial or subarachnoid outlets almost independently of the ftow they carry. In neonates and infants, this equilibrium represents a highly sensitive system. Any shift in the hydrodynamics will have a regional effect, and any decrease in the ventriculo-cortical gradient will alter the growth of the cortico-subcortical substance.