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MRI-brain for microcephaly?

19 Mar, 08 | by Bob Phillips

Boy with microcephalyA 7-year-old boy was referred for medical assessment as part of the process of producing a statement of special educational needs. There had been no medical concerns in the past and there was no family history of note. On examination, the boy was noted to be micro cephalic with head circumference on the 0.4th centile, while his height and weight were on the 50th centile. Neurological examination was normal. Should this boy be referred for an MRI scan of the brain?

Oh dear, I think I’m turning into a radiologist. “And what …” my mind is crying “will you do differently after I scan your child?” Perhaps I had to visit too many small dark rooms when I was a House Officer (*).

[Edit – May 2008]

Well, there is an answer of sorts … The summary of the literature surrounding this (by Dr Ambika Karthikeyan) found only three papers, all of poor quality, and none of them suggested any useful yield of diagnostic information. Unless we have a specific indication for scanning (or a study is conceived and open in your centre) then “no” to MRI seems like the right answer.

Acknowledgement
Image from Wikipedia

* – House Officer. {Archaic} Pre 2000 AD, an almost-qualified doctor who assessed patients, initiated investigations and formulated clinical management plans.

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  • vijayashankara

    No, I would not do a MRI scan, Instead I would do a IQ testing and plan how I can help the boy

  • Ian Wacogne

    Well…

    The MRI might tell you important autosomal recessive/autosomal dominant information. Which might give you information which will allow you give the family clear advice about future family.

    I doubt very much if the scan will tell you much about the future for the child, but it might have important consequences for his family.

  • vijayashankara

    I doubt the MRI would give a substantial information for family counselling; the cost of MRI scan, particularly in a developing country, will outweigh the benefits.

  • iwacogne

    OK, but there you have a different sort of argument.
    There is the cost/benefit question, and the question of whether this sort of investigation does have a yield which might have a benefit.

    I recognise that my view is developed-world centric, and I do, in my practice, have to consider cost/benefit for something like an MRI on the basis that it is a limited resource which I could quite easily mess up by over requesting. But it’s not the same question.

    The question is: does this test have the possiblity to change your managment, and if so, how frequently will performing this test do that, and by how much?

  • http://thevoltaschool.org Allison

    Actually, Kokuvi (pictured) is 16.

  • bphillips

    Allison – Thanks for the information! Clearly, all the images we use here in the site are illustrative, rather than representative.

  • http://thevoltaschool.org Allison

    If I were answering the question from the standpoint of someone who has personally worked with the boy in the picture in Ghana, I’d have to say no to the MRI for the same reasons as vijayashankara. Whilst in the first world, it’s a simple thing to get an MRI, in Hohoe, where Kokuvi lives, the closest MRI machine is either in Ho (1.5 hours) or Kumasi (~3 hours). Considering that the school doesn’t have transportation and that Kokuvi can’t easily be transported on public transportation, it makes absolutely no sense at all to take him in for an MRI. From his file, I can tell you that he’s never had a physical of any sort, but according to other employees at the school, his vision is impaired. He also has absolutely no attention span and the extent of his English is the word ‘chalk’. He doesn’t do much better in Ewe.

    Considering the extent of his microcephaly, I’d have to say that supportive therapy is better than delving in and trying any other recourse. Again, it may be different in America, but in Ghana, that’s the best we can really do.

  • http://www.medicexchange.com/ Radiology imaging

    Bob Phillips – Thanks for the information!

  • http://www.childrenwithmicro.org brandin

    I’m the vice president of The Foundation for Children with Microcephaly. We are dedicated to helping all persons with the dissorder, as well as all the medical insurance needed. We take charge in getting pediasure, diapers and funding for research. We also help with polymicrogyria also known as PMG. We work with Dr. Dobins and Dr Chang from the Walsh Clinic based in Chicago. A recent fact that our foundation learned by working with the Walsh Clinic was that one quarter of one percent of our worldwide population has autism. Thats not that many compared to people with microcephaly wich takes up two and a half percent of our world count. Not to mention the people who were born over 20 years ago who wouldnt have been diagnosed with microcephaly due to the number of specialist covering the dissorder and the certain technological advances we’ve all gone through. We have a Website and i ask that you check it out and refer families towards us. We offer moral support and information as well.Most of these children were told they would never talk, walk, or barely function. Most of these children proved doctors wrong. They our LITTLE MIRACLES. They are our inspiration. Please help us help others. http://www.childrenwithmicro.org is our website address. Please go over it yourselves and decide what you think of us before you pass it along. Thank you.

    Sincerely,
    Brandin Lewis

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