title: Globus pallidus high-signal lesions: A predominant MRI finding in children with neurofibromatosis type 1.
abstract: BACKGROUND
  Lesions of the brain, recognized as unidentified bright objects (UBOs), are commonly observed as areas of increased T2-weighted signal intensity on magnetic resonance imaging (MRI) in children with neurofibromatosis type 1 (NF1). Identification of these lesions is not currently encompassed in the National Institute of Health (NIH) diagnostic criteria for NF1.
  
  
  OBJECTIVE
  We aimed to determine the prevalence of UBOs in children with NF1 and identify areas of the brain that are commonly affected by these lesions, allowing us to evaluate whether UBOs should be included in the diagnostic criteria for the diagnosis of NF1.
  
  
  METHODS
  We reviewed the cranial MRI scans of 22 children who had been diagnosed with sporadic or familial NF1 in accordance with the criteria established by NIH. UBOs were present in 81% of the children with NF1.
  
  
  RESULTS
  These lesions have a predilection for specific areas of the brain, including the globus pallidus (72%), cerebellum (66%), brainstem (27%) and cerebral hemispheres (16%). The prevalence of UBOs identified varied significantly with age and sex; they were infrequent in children less than 4 years of age but were common in those aged between 4 and 12 years of age. UBOs were more commonly seen in males (66.6%) compared with females (33.3%). Repeat MRI scan on a subset of these patients with UBOs did not show any significant changes despite a worsening in clinical symptoms.
  
  
  CONCLUSIONS
  We have shown that UBOs are a common finding in children with NF1, and are most prevalent between the ages of 4 and 12 years. Many sites of the brain are affected by these lesions, most notably the globus pallidus and the cerebellum. Further research must be conducted to elucidate the significance of UBOs in patients with NF1 and whether these lesions have any utility in the clinical detection of NF1.
authors: Department of Pediatric Neurology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
authors: Arif
authors: A
authors: Khan
authors: Sushil
authors: S
authors: Beri
authors: Aravindhan
authors: A
authors: Baheerathan
authors: Anand
authors: A
authors: Balki
authors: Nahin
authors: N
authors: Hussain
authors: Jayprakash
authors: J
authors: Gosalakkal
keywords: Globus pallidus; magnetic resonance imaging; neurofibromatosis type 1; unidentified bright objects
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