Apparent cerebral atrophic findings on cranial computed tomography in nephrotic children with steroid therapy and in patients of infantile spasms with acth therapy.

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Abstract
This study examined the influence of corticosteroids and ACTH on the brain of patients with nephrotic syndrome and infantile spasms by means of cranial computed tomography (CCT).CSF-space/intracranial space (C/I) ratio was used as a parameter of ap-parent cerebral atrophic findings, that is, the enlargement of the ventricles and the subarachnoid space. C/I ratio was calculated by computer processing of CCT at the level of the 3 rd and lateral ventricles. This is the first report in which computer processing is applied to the evaluation of CCT findings to study the effects of steroids and ACTH on the brain.Twelve of fifteen nephrotic patients showed abnormal C/I ratio after in-tensive steroid therapy. The average dose was 2147 mg of prednisolone for 3 weeks to 5 months. The average C/I ratio in the fifteen patients was 6.6 ± 3.9 % compared with 1.6 ± 0.8 % in 34 control individuals. The C/I ratio in the twelve patients with abnormally high values decreased to 2.6 ± 1.5% after reduction or withdrawal of steroids. The C/I ratio returned to normal in 9 of 12 patients at that time.In all patients treated with ACTH, C/I ratios increased significantly dur-ing ACTH therapy. In 8 patients with infantile spasms, C/I ratios were 5.1 ± 3.9 % before, 16.4 ± 7.8 % during, and 6.2 ± 3.3 % between 2 and 20 months after the withdrawal of therapy (0.25 to 0.5 mg/day of ACTH, IM., for 2 to 3 weeks).Although apparent cerebral atrophic findings were reversible in these patients, the data suggests that corticosteroid and ACTH can cause morphological changes of the cerebra in children as evaluated by CCT. The long-term and massive administration of steroids or ACTH should be minimized in children with growing cerebra, especially in neonates and infants.

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