Altered Mental Status

Lehman, Rebecca; Mink, Jonathan W.

doi:10.1016/j.cpem.2008.02.003

Cited by 9 publications

(5 citation statements)

References 2 publications

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“…The risk factors for ischemic perioperative complications could be a history of TIAs, previous stroke/s, severity of disease, intraoperative hypotension, hypovolemia, significant reduction in hematocrit or increase in viscosity due to hemoconcentration, and intraoperative hypo-or hypercapnia. [2][3][4] Essentially, perioperative management of MMD in pediatric patients is an art of balancing the optimal anesthetic state with the surgical stress and provision of a calm, relaxed patient postoperatively with adequate postoperative analgesia. Thus, a fine balance to maintain normoxia, normoventilation, normocarbia, normothermia, and normovolemia (5N) seems to be extremely important to prevent any ischemic episode perioperatively in children.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical revascularization has shown to improve long-term outcome in children with MMD. [2][3][4] Perioperative ischemic complication incidence has been reported to be 5%-20% in surgical series of moyamoya patients. [5] To add to the anguish, monitoring methods to reduce the risk of perioperative ischemia are not identified as yet, and strict adherence to the maintenance of adequate cerebral perfusion perioperatively can lead to a successful outcome.…”

Section: Introductionmentioning

confidence: 99%

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Anesthetic challenges in pediatric moyamoya disease: A report of two cases

et al. 2020

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Moyamoya disease (MMD), a rare cause of pediatric stroke, is a cerebrovascular occlusive disorder resulting from progressive stenosis of the distal intracranial carotid arteries and their proximal branches. In response to brain ischemia, there is the development of basal collateral vessels, which gives rise to the characteristic angiographic appearance of moyamoya (puff of smoke). If left untreated, the disease can result in overwhelming permanent neurological and cognitive deficits. Whereas MMD refers to the idiopathic form, moyamoya syndrome refers to the condition in which children with moyamoya also have a recognized clinical disorder. The classic pediatric presentation in moyamoya is recurrent transient ischemic attacks (TIAs) and/or completed/repeated ischemic strokes. Surgical revascularization, including direct and indirect techniques, remains the mainstay of treatment and has been shown to improve long-term outcome in children with MMD. Various risk factors identified for perioperative complications are as follows: history of TIAs, severity of disease, intraoperative hypotension, hypercapnia and hypovolemia, and substantial reduction in hematocrit intraoperatively. Thus, providing perianesthetic care to pediatric patients undergoing revascularization procedure for MMD is like walking a tightrope, and we present two such cases handled successfully.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Anesthetic challenges in pediatric moyamoya disease: A report of two cases

et al. 2020

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“…Medical ones cause an encephalopathic state by causing diffuse dysfunction of both cerebral hemispheres. Structural causes can produce unequal or unreactive pupils as well as focal neurological findings but sometimes occur without focality such as with bilateral cerebrovascular disease or early hydrocephalus [10]. Most general medical conditions were excluded by normal blood, urine studies and negative history of fever or trauma.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Moyamoya disease

Allarakhia

2013

Am J Case Rep

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Background:Moyamoya disease (MMD) is a progressive cerebrovascular occlusive disease of the bilateral internal carotid arteries that leads to a compensatory abnormal vascular network at the base of the brain. Its average annual incidence 0.54 per 100,000 population but it is the most common pediatric cerebrovascular disease in East Asia. The reported incidence in USA is approximately 0.086 per 100,000 patients.Case Report:We present a case of Moyamoya disease that was to detected in a 7-year-old female who presented with transient altered mental status.Conclusions:Moyamoya disease can be diagnosed if history, physical exam and brain imaging is highly suspicious. Conventional angiography remains the gold standard for diagnosis and aids in surgical planning for patients with suspected Moyamoya disease.

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“…9 The differential diagnosis for mental status changes in children includes structural, metabolic, infectious, autoimmune, toxic, and neurodegenerative causes. 16 Inborn errors of metabolism are often overlooked in older children, but should be considered in the first tier of diagnosis, particularly when the family history is contributory or when parents are consanguineous. As our case also illustrates, metabolic disorders can cause acute or subacute symptoms after a period of normal development.…”

Section: Discussionmentioning

confidence: 99%

“…Screening chemistries, hematologic studies, and microbiological tests can help to guide the evaluation. 16 The yield of additional tests, including ammonia, lactate, pyruvate, urine and plasma amino acids, fatty acid, and carnitine profiles and various vitamin levels, depends on the clinical context. 17 Autoimmune causes can be evaluated by testing for individual antibodies, including antithyroid or paraneoplastic antibodies.…”

Section: Discussionmentioning

confidence: 99%

A Treatable Metabolic Cause of Encephalopathy: Cobalamin C Deficiency in an 8-Year-Old Male

Krueger¹,

Piantino

Smith

et al. 2015

Pediatrics

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Neurologic regression in a previously healthy child may be caused by metabolic or neurodegenerative disorders, many of which have no definitive treatment. We report a case of a previously healthy 8-year-old boy who presented with a month-long history of waxing and waning encephalopathy and acute regression, followed by seizures. Evaluation for a metabolic disorder revealed methylmalonic acidemia and hyperhomocysteinemia of the cobalamin C type due to a single, presumed homozygous pathogenic c.394 C.T mutation in the MMACHC gene. With the appropriate diet restrictions and vitamin replacement, he improved significantly and returned to his premorbid level of behavior. This case illustrates an unusual presentation of a treatable metabolic disorder and highlights the need to consider cobalamin defects in the differential diagnosis of healthy children with neurologic regression.

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Altered Mental Status

Cited by 9 publications

References 2 publications

Anesthetic challenges in pediatric moyamoya disease: A report of two cases

Anesthetic challenges in pediatric moyamoya disease: A report of two cases

Pediatric Moyamoya disease

A Treatable Metabolic Cause of Encephalopathy: Cobalamin C Deficiency in an 8-Year-Old Male

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