title: T2 hyperintense signal of the central tegmental tracts in children: disease or normal maturational process?
abstract: BACKGROUND
  Cerebral central tegmental tract hyperintense signal on T2-weighted MRI (CTTH) is known from various clinical conditions, including children treated with vigabatrin (VGB) for West syndrome (WS), with hypoxic-ischemic brain injury, and metabolic diseases. Considering this clinical diversity, we hypothesized that CTTH might primarily mirror a physiologic process.
  
  
  METHODS
  We retrospectively analysed brain MRI data of the central tegmental tracts deriving from four different groups: (1) children with WS and VGB therapy (WS+VGB+), (2) children with WS but without VGB therapy (WS+VGB-), (3) children with different neurological diseases (WS-VGB-; maximum age 15 years), and (4) controls younger than 25 months of age (this age includes the peak age of WS).
  
  
  RESULTS
  CTTH were detected in 4/17 WS+VGB+ children (24%), 4/34 WS+VGB- children (12%), 18/296 WS-VGB- children (6%), and 8/112 controls (7%). Independently from the underlying diagnosis, CTTH showed a peak age during early infancy and were not found before 4 months and after 7 years of life. The rate of CTTH among WS children ± VGB therapy was similar so that VGB therapy seems of minor etiological impact. However, comparison of WS patients younger than 25 months of age (CTTH present in 7/40) with age-matched controls (CTTH present in 8/112) revealed that CTTH tend to be more frequent among WS patients in general.
  
  
  CONCLUSIONS
  Our study suggests that CTTH represents a physiological maturation-related process. The high prevalence of CTTH among patients with WS indicates that this physiological process may be modified by additional endo- or exogeneous factors.
authors.affiliation: Pediatric Neurology Unit, Department of Pediatrics, Navarra Health Service, Pamplona, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Aguilera-Albesa
authors.forename: Andrea
authors.initials: A
authors.lastname: Poretti
authors.forename: Dagmar
authors.initials: D
authors.lastname: Honnef
authors.forename: Meral
authors.initials: M
authors.lastname: Aktas
authors.forename: Maria Eugenia
authors.initials: ME
authors.lastname: Yoldi-Petri
authors.forename: Thierry A G M
authors.initials: TA
authors.lastname: Huisman
authors.forename: Martin
authors.initials: M
authors.lastname: Häusler
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D013036:Spasms, Infantile / Q000188:drug therapy* / Q000473:pathology*; D013681:Tegmentum Mesencephali / Q000473:pathology*; D020888:Vigabatrin / Q000627:therapeutic use*
chemical_list: D000927:Anticonvulsants; D020888:Vigabatrin