Kalina, Peter

Objective To compare the effectiveness of rituximab (RTX) with cyclophosphamide (CYC) in patients who have central nervous system (CNS) involvement in antineutrophil cytoplasmic antibody–associated vasculitis (AAV). Methods A computer-assisted search was conducted to identify all adults who received a diagnosis of AAV with CNS involvement from January 1, 1997, through July 1, 2017, at our institution. Results Of the 17 patients identified, 11 had received RTX, and 6 had received CYC. Age at diagnosis of CNS involvement was similar in both groups. In the RTX group, 91% of the patients were women; in the CYC group, 33% were women (p = 0.03). At the time of CNS presentation, orbital involvement had occurred in 6 patients in the RTX group and in none of the patients in the CYC group. Initial remission of induction was achieved in all patients (100%) in the CYC group and in 10 patients (91%) in the RTX group. Two patients had no response to RTX: 1 patient when RTX was used for remission induction at the time of diagnosis and the second patient when RTX was used for remission induction after relapse. The median follow-up was 38 months (range, 9–127 months). Central nervous system relapse occurred in 4 patients in the RTX group and in 1 patient in the CYC group. Of the 4 patients in the RTX group with relapse, 3 had marked ocular involvement. Both nonresponder patients in the RTX group had ocular involvement. Conclusion Rituximab is as effective as CYC in remission induction in patients with CNS involvement in AAV.

AbstractEvaluation of abusive head trauma (AHT) in children is an ongoing diagnostic challenge, as there are currently no standard criteria or objective tests for differentiating AHT from accidental trauma. The use of neuroradiologic imaging has an increasingly important role in identifying AHT and often involves a combination of skull radiographs, computerized tomography (CT), and conventional magnetic resonance imaging (MRI) with diffusion-weighted imaging, susceptibility-weighted imaging, and occasionally magnetic resonance spectroscopy. Development of more advanced imaging techniques includes diffusion tensor imaging and arterial spin labeling. MRI may provide insight into different mechanisms of injury and long-term impacts of AHT. A better understanding of the available imaging modalities, typical findings, and their respective contribution to an accurate diagnosis can help guide physicians, other health care providers, as well as law enforcement in the evaluation of children with suspected AHT.