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Aim: Moyamoya disease (MMD) is a rare, progressive and oclusive cerebrovascular disorder, predominantly affecting the terminal segment of the internal carotid arteries (ICA) and its main branches. The purpose of this study is to evaluate the clinical course and severity of MMD in pediatric patients. Material and Method: We examined 5 consecutive pediatric patients with MMD, focusing on clinical and radiological features, the therapy and outcome over the 58-month follow-up period. Results: The study population consisted of 3 boys and 2 girls. The mean age at diagnosis of patients was 7.2 ± 3.4 years (age range: 3-10 years). The mean duration of follow-up was 30.4 ± 17.4 months (follow-up interval: 12-58 months). Neurological findings at presentation included: motor deficit in 4 patients (80.0%), epileptic seizures in 2 patients (40.0%), movement disorders in 3 patients (60.0%), and headache in 1 patients (20.0%). There was areas of infarction on brain MRI in all patients. Angiographic findings included: internal carotid artery stenosis in all patients, anterior cerebral artery stenosis in 3 patients, middle cerebral artery stenosis in 3 patients, posterior cerebral artery stenosis in 2 patients, and vertebral artery stenosis in 1 patient. Enoxaparine therapy was started to all patients. Subdural hematoma developed in 1 patient during follow-up. Cerebral infarctions recurred despite medical treatment in 4 patients. Discussion: Although this disease is rare, it is an important cause of pediatric stroke. MMD shows different clinical course and disease severity in childhood. Early diagnosis and appropriate treatment are crucial.

Aim: To overview the medical history, clinical signs, imaging studies, laboratory data and treatment effectiveness in children with acute idiopathic transverse myelitis. Material and Method: Eight patients under the age of 15 years who presented acute transverse myelitis were included in the study by using the criteria of the Transverse Myelitis Consortium Working Group (2002). Chart analysis, clinical evaluation, imaging studies, laboratory data and treatment effectiveness were evaluated retrospectively. The study approved by the ethics committee (07.08.2012/488). Results: Five patients were boys and 3 were girls. The mean age was 9.00 ± 4.7 years. The most common symptoms were weakness (7/8) and urinary incontinence (2/8). Concurrent upper respiratory tract infection was present in 5 patients and lower respiratory tract infection in 2 patients. On magnetic resonance imaging of spine, there were cervical involvement in 5 cases, thoracic involvement in 7 patients, and lumbar involvement, in 5 patients There was concurrent cervical and thoracic spinal cord involvement in 1 patient, thoraco-lumball spinal cord involvement in 2 patients and total cord involvement in 3 patients All patients were treated with high-dose methylprednisolone, 5 patients received intravenous IgG, and 2 patients underwent plasmapheresis. The most common sequel was neurogenic bladder in 7 cases, followed by paraplegia and quadriplegia which were both observed in 3 cases. Discussion: Persistent neurogenic disability is common in children with acute transverse myelitis. Cervical involvement and the extent of the involving segment are associated with poor prognosis.

Mirror movements are involuntary movements that occur in homologous contralateral muscles on voluntary activation. Persistent mirror movements may be associated with congenital malformations; however, familial syndromes or sporadic cases without any associated anomalies are are also noted. Klippel-Feil syndrome is a congenital malformation that exists secondary to the failure of the normal segmentation of cervical somites during the third and eighth weeks of gestation. Hereby, we present two cases with mirror movement: isolated and associated with Klippel-Feil syndrome.