ORCID Profile
0000-0002-2443-7958
Current Organisations
University of Southampton
,
University College London
,
Southampton University Hospitals NHS Trust
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Publisher: Springer Science and Business Media LLC
Date: 09-06-2020
Publisher: Wiley
Date: 10-2009
Publisher: Oxford University Press (OUP)
Date: 05-2016
DOI: 10.5665/SLEEP.5740
Publisher: BMJ
Date: 04-1991
Abstract: Three cases are presented in which clinical and radiological features suggested the diagnosis of glioma but surgical biopsy revealed a demyelinating process, with tissue destruction and cyst formation in two. One patient had clinically definite multiple sclerosis. Two had probable acute disseminated encephalomyelitis. Treatment with high dose steroids is appropriate when there is clinical or investigative evidence to suggest the presence of demyelinating disease, before deciding on biopsy.
Publisher: Elsevier BV
Date: 06-2007
DOI: 10.1016/J.NEUROIMAGE.2007.02.051
Abstract: We examined MRI abnormalities and language function in young patients with infarctions apparently confined to the basal ganglia to establish whether impaired performance was attributable to basal ganglia damage per se or to additional cerebral abnormalities. Seventeen stroke patients (10 with left- and 7 with right-hemispheric damage) and seventeen controls participated. MRI included perfusion imaging and voxel-based morphometry analyses of T1-weighted and diffusion data sets. Language was assessed using the CELF-III test. Analysis of CELF-III scores showed a main effect of presence or absence of stroke, with patients performing more poorly than controls. There was no evidence of differences between the left- and right-hemisphere groups. However in idual patients with left-hemisphere lesions showed large variations in performance. In the patients with left-hemisphere damage, voxel-based morphometry showed significant relationships between language function and gray matter density in cortical language areas. The white matter analyses also showed correlations with language function, and in addition there were hemodynamic abnormalities in cortical language areas in the three patients with poorest language function. We suggest that language impairments following basal ganglia damage may be attributable primarily to abnormalities in cortical language areas that are too subtle to detect on conventional structural MRI.
Publisher: Ferrata Storti Foundation (Haematologica)
Date: 30-06-2009
Publisher: American Thoracic Society
Date: 08-2016
Publisher: Elsevier BV
Date: 09-2011
Publisher: Elsevier BV
Date: 09-2011
DOI: 10.1016/J.EJPN.2011.04.005
Abstract: The literature on paediatric acute-onset movement disorders is scattered. In a prospective cohort of 52 children (21 male age range 2mo-15y), the commonest were chorea, dystonia, tremor, myoclonus, and Parkinsonism in descending order of frequency. In this series of mainly previously well children with cryptogenic acute movement disorders, three groups were recognised: (1) Psychogenic disorders (n = 12), typically >10 years of age, more likely to be female and to have tremor and myoclonus (2) Inflammatory or autoimmune disorders (n = 22), including N-methyl-d-aspartate receptor encephalitis, opsoclonus-myoclonus, Sydenham chorea, systemic lupus erythematosus, acute necrotizing encephalopathy (which may be autosomal dominant), and other encephalitides and (3) Non-inflammatory disorders (n = 18), including drug-induced movement disorder, post-pump chorea, metabolic, e.g. glutaric aciduria, and vascular disease, e.g. moyamoya. Other important non-inflammatory movement disorders, typically seen in symptomatic children with underlying aetiologies such as trauma, severe cerebral palsy, epileptic encephalopathy, Down syndrome and Rett syndrome, include dystonic posturing secondary to gastro-oesophageal reflux (Sandifer syndrome) and Paroxysmal Autonomic Instability with Dystonia (PAID) or autonomic 'storming'. Status dystonicus may present in children with known extrapyramidal disorders, such as cerebral palsy or during changes in management e.g. introduction or withdrawal of neuroleptic drugs or failure of intrathecal baclofen infusion the main risk in terms of mortality is renal failure from rhabdomyolysis. Although the evidence base is weak, as many of the inflammatory/autoimmune conditions are treatable with steroids, immunoglobulin, plasmapheresis, or cyclophosphamide, it is important to make an early diagnosis where possible. Outcome in survivors is variable. Using illustrative case histories, this review draws attention to the practical difficulties in diagnosis and management of this important group of patients.
Publisher: Wiley
Date: 21-07-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-11-2017
DOI: 10.1212/WNL.0000000000004728
Abstract: The purpose of this study of sickle cell disease (SCD) was to determine whether arteriopathy, measurable as intracranial vessel signal loss on magnetic resonance angiography (MRA), was associated with low nocturnal hemoglobin oxygen saturation (SpO 2 ) or hemolytic rate, measurable as reticulocytosis or unconjugated hyperbilirubinemia. Ninety-five East London children with SCD without prior stroke had overnight pulse oximetry, of whom 47 (26 boys, 39 hemoglobin SS mean age 9.1 ± 3.1 years) also had MRA, transcranial Doppler (TCD), steady-state hemoglobin, and reticulocytes within 34 months. Two radiologists blinded to the other data graded arteriopathy on MRA as 0 (none) or as increasing severity grades 1, 2, or 3. Grades 2 or 3 arteriopathy (n = 24 2 with abnormal TCD) predicted stroke/TIA compared with grades 0 and 1 (log-rank χ 2 [1, n = 47] = 8.1, p = 0.004). Mean overnight SpO 2 correlated negatively with reticulocyte percentage ( r = −0.387 p = 0.007). Despite no significant differences across the degrees of arteriopathy in genotype, mean overnight SpO 2 was higher ( p 0.01) in those with grade 0 (97.0% ± 1.6%) than those with grades 2 (93.9 ± 3.7%) or 3 (93.5% ± 3.0%) arteriopathy. Unconjugated bilirubin was not associated but reticulocyte percentage was lower ( p 0.001) in those with grade 0 than those with grades 2 and 3 arteriopathy. In multivariable logistic regression, lower mean overnight SpO 2 (odds ratio 0.50, 95% confidence interval 0.26–0.96 p 0.01) predicted arteriopathy independent of reticulocyte percentage (odds ratio 1.47, 95% confidence interval 1.15–1.87 p = 0.003). Low nocturnal SpO 2 and reticulocytosis are associated with intracranial arteriopathy in children with SCD. Preventative strategies might reduce stroke risk.
Publisher: Elsevier BV
Date: 04-2018
Publisher: Wiley
Date: 24-03-2010
DOI: 10.1111/J.1467-7687.2009.00909.X
Abstract: Millions of people currently live at altitudes in excess of 2500 metres, where oxygen supply is limited, but very little is known about the development of brain and behavioural function under such hypoxic conditions. We describe the physiological, cognitive and behavioural profile of a large cohort of infants (6-12 months), children (6-10 years) and adolescents (13-16 years) who were born and are living at three altitude locations in Bolivia ( approximately 500 m, approximately 2500 m and approximately 3700 m). Level of haemoglobin oxygen saturation and end-tidal carbon dioxide were significantly lower in all age groups living above 2500 metres, confirming the presence of hypoxia and hypocapnia, but without any detectable detriment to health. Infant measures of neurodevelopment and behaviour yielded comparable results across altitude groups. Neuropsychological assessment in children and adolescent groups indicated a minor reduction in psychomotor speed with increasing altitude, with no effect of age. This may result from slowing of underlying brain activity in parallel with reduced cerebral metabolism and blood flow, evidenced here by reduced cerebral blood flow velocity, particularly in the basilar artery, in children and adolescents. The proportion of European, Native American and African genetic admixture was comparable across altitude groups, suggesting that adaptation to high altitude in these children occurred in response to chronic hypoxic exposure irrespective of ethnic origin. Thus, psychomotor slowing is proposed to be an adaptive rather than a deficient trait, perhaps enabling accuracy of mental activity in hypoxic conditions.
Publisher: Wiley
Date: 30-08-2010
DOI: 10.1111/J.1469-8749.2010.03775.X
Abstract: Mortality from malignant middle cerebral artery infarction (MMCAI) approaches 80% in adult series. Although decompressive craniectomy decreases mortality and leads to an acceptable outcome in selected adult patients, there are few data on MMCAI in children with stroke. This study evaluated the frequency of MMCAI and the use of decompressive craniectomy in children. We retrospectively reviewed cases of MMCAI from five pediatric tertiary care centers. Ten children (two females, eight males median age 9y 10mo, range 22mo-14y) had MMCAI, with a median Glasgow Coma Scale score of 6 (range 3-9). MMCAI represented fewer than 2% of cases of pediatric arterial ischemic stroke. Three patients who did not undergo decompression, all of whom had monitoring of intracranial pressure, developed intractable intracranial hypertension, and fulfilled criteria for brain death. In contrast, seven patients underwent decompressive craniectomy and survived, with rapid improvement in their level of consciousness postoperatively. All seven survivors now walk independently with mild to moderate residual hemiparesis and speak fluently, even though four had left-sided infarcts. Decompressive craniectomy can lead to a moderately good outcome for children with MMCAI and should be considered, even with symptomatic stroke and deep coma. Monitoring of intracranial pressure may delay life-saving treatment.
Publisher: American Academy of Pediatrics (AAP)
Date: 07-2007
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Fenella Kirkham.