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The percutaneous placement of ventriculoatrial (VA) shunts has been previously described, usually in adults. We report a series of 7 pediatric cases ranging from 6 to 17 years. Five patients were female and 2 were male. All patients had prior ventriculoperitoneal (VP) shunts for hydrocephalus, of which 1 had been subsequently converted to a ventriculopleural shunt. Indications for conversion to a VA shunt were intra-abdominal infection in 6 cases and chronic pleuritic chest pain in 1 patient. The venous entry was the subclavian vein in all cases. All patients have remained asymptomatic since the operation. There were no complications associated with the procedures, with follow-up ranging from 2 to 12 months. This technique is a viable alternative to the open cervical approach for venous entry to the right atrium in the pediatric population. [ABSTRACT FROM AUTHOR]

Background To study the incidence of cerebellar tonsillar ectopia and Chiari type symptoms in a population of LMM patients. Materials and methods The records of patients with a diagnosis of LMM between the years of 1978 and 2003 (130 patients) at Children's Hospital and Regional Medical Center (CHRMC) in Seattle, Washington were reviewed. The presence and degree of tonsillar ectopia was determined by reviewing total spine and brain MRIs (sagittal T1 sequences) from these patients. We defined significant ectopia as greater than 5 mm below the foramen magnum. We limited the study to the 46 out of 130 patients who had previous MRIs. Clinic notes from yearly clinic visits were also reviewed in order to determine the presence of symptoms such as headaches, shoulder pain and bulbar symptoms. We used Fisher's exact test of proportions. Results We identified cerebellar tonsillar ectopia greater than 6 mm in 14/46 (30%) of the patients. The degree of tonsillar ectopia ranged from 6 to 13 mm below the foramen magnum. Review of the medical records of all 46 patients which included a yearly clinic visit until the age of 21, revealed that 6/14 patients with significant tonsillar ectopia had frequent headaches associated with cough or valsalva, while only 1/32 patients without significant ectopia had headaches (P = 0.002). Patients with significant ectopia were not more likely to have multiple detethering operations (4/14 (29%) in the ectopia subgroup versus 5/32 (16%) in patients without significant ectopia) (P = 0.3). There was no correlation between the number of detethering operations and degree of tonsillar ectopia within each group. Also, no correlation between the age of the patient at initial repair and the degree of tonsillar ectopia was observed. Conclusion This study has revealed a 42-fold increase in the incidence of pathologic cerebellar tonsillar ectopia in LMM patients in comparison with historical controls. In addition we have identified symptoms suggestive of Chiari type I malformation in greater than half of the patients within this subgroup. [ABSTRACT FROM AUTHOR]

Presents information on a 20-year-old woman who suffered from severe dystonia and spasticity following a suicide attempt with disulfiram ingestion at age 14 years. Neuropsychiatric symptoms of disulfiram toxicity; Features of disulfiram-mediated encephalopathy; Outcome of baclofen therapy.