Neuromonitoring in Children with Cerebrovascular Disorders

Harrar, Dana; Sun, Lisa R.; Segal, Jacob; Lee, Sarah; Sansevere, Arnold J.

doi:10.1007/s12028-023-01689-2

Cited by 5 publications

(2 citation statements)

References 196 publications

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“…Excessive reliance on ICP monitoring and values can prove counterproductive and might delay management until irreversible herniation has occurred. Newly available bedside neuromonitoring including transcranial Doppler, pupillometry, and quantitative EEG are promising tools to detect early deterioration [ 73 , 74 ].…”

Section: Discussionmentioning

confidence: 99%

Decompressive hemicraniectomy in pediatric malignant arterial ischemic stroke: a case-based review

et al. 2023

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Purpose Malignant stroke is a life-threatening emergency, with a high mortality rate (1–3). Despite strong evidence showing decreased morbidity and mortality in the adult population, decompressive hemicraniectomy (DCH) has been scarcely reported in the pediatric stroke population, and its indication remains controversial, while it could be a potential lifesaving option. Methods and results We performed an extensive literature review on pediatric malignant arterial ischemic stroke (pmAIS) and selected 26 articles reporting 97 cases. Gathering the data together, a 67% mortality rate is observed without decompressive therapy, contrasting with a 95.4% survival rate with it. The median modified Rankin score (mRS) is 2.1 after surgery with a mean follow-up of 31.8 months. For the 33% of children who survived without surgery, the mRS is 3 at a mean follow-up of 19 months. As an illustrative case, we report on a 2-year-old girl who presented a cardioembolic right middle cerebral artery stroke with subsequent malignant edema and ongoing cerebral transtentorial herniation in the course of a severe myocarditis requiring ECMO support. A DCH was done 32 h after symptom onset. At the age of 5 years, she exhibits an mRS of 3. Conclusion Pediatric stroke with malignant edema is a severe condition with high mortality rate if left untreated and often long-lasting consequences. DCH might minimize the vicious circle of cerebral swelling, increasing intracranial pressure and brain ischemia. Our literature review underscores DCH as an efficient therapeutic measure management of pmAIS even when performed after a significant delay; however, long-lasting morbidities remain high.

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Section: Discussionmentioning

confidence: 99%

Decompressive hemicraniectomy in pediatric malignant arterial ischemic stroke: a case-based review

et al. 2023

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“…cEEG monitoring has been used as a neuromonitoring tool in the PICU to guide management and provide prognostic information for a diverse group of neurologic disorders including traumatic brain injury, stroke, cardiac arrest, and congenital cardiac defects. (17,18,19,20) EEG has not been studied systematically in IEMs and therefore, there is a lack of data regarding its usefulness in these disorders. (21) We present our data over 10 years from a single center studying EEG characteristics in our cohort.…”

Section: Introductionmentioning

confidence: 99%

Seizure Characteristics and EEG Features in Intoxication Type and Energy Deficiency Neurometabolic Disorders in the Pediatric Intensive Care Unit– Single Center Experience over 10 Years

Sen,

Harrar,

Pariseau

et al. 2024

Preprint

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Introduction: Acute metabolic crises in inborn errors of metabolism (such as Urea Cycle Disorders, Organic Acidemia, Maple Syrup Urine Disease and Mitochondrial disorders) are neurological emergencies requiring management in the pediatric intensive care unit (PICU). There is paucity of data pertaining to EEG characteristics in this cohort. We hypothesized that the incidence of background abnormalities and seizures in this cohort would be high. Neuromonitoring data from our center’s PICU over 10 years is presented in this paper.Methods Data was collected by retrospective chart review for patients with the afore-mentioned disorders who were admitted to the PICU at our institution due to metabolic/ neurologic symptoms from 2008–2018. Descriptive statistics (Chi-square test or Fisher’s exact test) were used to study the association between EEG parameters and outcomes.Results Our cohort included 40 unique patients (8 UCD, 7 OA, 3 MSUD and 22 MD) with 153 admissions. Presenting symptoms included altered mentation (36%), seizures (41%), focal weakness (5%), and emesis (28%). Continuous EEG was ordered in 34% (n = 52) of admissions. Twenty-three admissions were complicated by seizures, including 8 manifesting status epilepticus (7 nonconvulsive, 1 convulsive). Asymmetry and focal slowing on EEG were associated with seizures. Moderate background slowing or worse was noted in 75% of EEGs. Among those patients monitored on EEG with a known outcome at discharge, 4 (8%) died, 3 (6%) experienced a worsening of their Pediatric Cerebral Performance Category (PCPC) score as compared to admission, and 44 (86%) had no change (or improvement) in their PCPC score during admission.Conclusion This study shows a high incidence of clinical and subclinical seizures during metabolic crisis in patients with IEMs. EEG background features were associated with risk of seizures as well as discharge outcomes. This is the largest study to date which investigates EEG features and risk of seizures in patients with neurometabolic disorders admitted to PICUs. This data can be used to form neuromonitoring protocols to improve mortality and morbidity in IEMs.

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Pediatric Moyamoya Revascularization Perioperative Care: A Modified Delphi Study

et al. 2023

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Neuromonitoring in Children with Cerebrovascular Disorders

Cited by 5 publications

References 196 publications

Decompressive hemicraniectomy in pediatric malignant arterial ischemic stroke: a case-based review

Decompressive hemicraniectomy in pediatric malignant arterial ischemic stroke: a case-based review

Seizure Characteristics and EEG Features in Intoxication Type and Energy Deficiency Neurometabolic Disorders in the Pediatric Intensive Care Unit– Single Center Experience over 10 Years

Pediatric Moyamoya Revascularization Perioperative Care: A Modified Delphi Study

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