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Pediatric stroke

Gabriel DeVela, J Michael Taylor, Bin Zhang, Luke L Linscott, Alan M Chen, Kunal B Karani, Andrew Furthmiller, James L Leach, Sudhakar Vadivelu, Todd Abruzzo
BACKGROUND AND PURPOSE: Quantitative arterial tortuosity (QAT) is a ratio of vessel length between 2 points to the shortest linear distance between same points. QAT has been reported as an imaging biomarker of arteriopathy in pediatric arterial ischemic stroke (AIS) because of dissection and transient cerebral arteriopathy. We sought to determine whether QAT abnormalities are present in other subtypes of pediatric AIS. METHODS: Children with AIS-absent conventional biomarkers of arteriopathy and case-controls who underwent magnetic resonance angiography were classified by stroke mechanism...
March 14, 2018: Stroke; a Journal of Cerebral Circulation
Samuel Wittekind, Wayne Mays, Yvette Gerdes, Sandra Knecht, John Hambrook, William Border, John Lynn Jefferies
Patients with a Fontan circulation have impaired exercise capacity. Cardiac rehabilitation (CR) has shown promise in enhancing peak exercise parameters in this population, but an improvement in submaximal exercise has not been consistently demonstrated. We assessed the hypothesis that participation in CR will be associated with more efficient oxygen extraction and ventilation during submaximal exercise. In this prospective study, pediatric Fontans completed two 60 min CR sessions per week for 12 weeks. Cardiopulmonary exercise testing and stress echocardiography were performed at baseline and last CR session, and then compared with a paired sample t test...
March 9, 2018: Pediatric Cardiology
Elliot Long, Trevor Duke, Ed Oakley, Adam O'Brien, Bennett Sheridan, Franz E Babl
OBJECTIVE: The intent of fluid bolus therapy (FBT) is to increase cardiac output and tissue perfusion, yet only 50% of septic children are fluid responsive. We evaluated respiratory variation of inferior vena cava (IVC) diameter as a predictor of fluid responsiveness. METHODS: A prospective observational study in the ED of The Royal Children's Hospital, Melbourne, Australia. Patients were spontaneously ventilating children treated with FBT for sepsis-induced acute circulatory failure...
March 8, 2018: Emergency Medicine Australasia: EMA
Lori C Jordan, Dionna O Roberts Williams, Mark J Rodeghier, Brittany Covert, Maria R Ponisio, James F Casella, Robert C McKinstry, Michael J Noetzel, Fenella J Kirkham, Emily R Meier, Beng Fuh, Melissa McNaull, Sharada Sarnaik, Suvankar Majumdar, Timothy L McCavit, Michael R DeBaun
In a prospective cohort study, we tested the hypothesis that children with sickle cell anemia (SCA) with normal transcranial Doppler ultrasound (TCD) velocities and without silent cerebral infarcts (SCIs) would have a lower incidence rate of new neurological events (strokes, seizures or transient ischemic attacks) compared to children with normal TCD measurements and SCIs, not receiving regular blood transfusions. Non-randomized participants from the Silent Cerebral Infarct Transfusion (SIT) Trial who had screening magnetic resonance imaging (MRI) of the brain and normal TCD measurements were included...
March 9, 2018: American Journal of Hematology
Satvinder K Ghotra, Jeffrey A Johnson, Weiyu Qiu, Amanda S Newton, Carmen Rasmussen, Jerome Y Yager
OBJECTIVE: Health-related quality of life (HRQL) instruments are patient or proxy-reported outcome measures that provide a comprehensive and subjective assessment of patient's well-being and hence vital for health outcomes evaluation. A clear and thorough understanding of HRQL and its determinants is especially important to appropriately guide health-improving interventions. In this study, HRQL of paediatric arterial ischaemic stroke survivors was assessed using guidelines recommended for interpretation and reporting of the patient-reported outcome data...
March 8, 2018: Archives of Disease in Childhood
Dmitry Telyshev, Maxim Denisov, Alexander Pugovkin, Sergey Selishchev, Igor Nesterenko
In this work, the study results of an implantable pediatric rotary blood pump (PRBP) are presented. They show the results of the numerical simulation of fluid flow rates in the pump. The determination method of the backflows and stagnation regions is represented. The operating points corresponding to fluid flow rates of 1, 3, and 5 L/min for 75-80 mm Hg pressure head are investigated. The study results have shown that use of the pump in the 1 L/min operating point can potentially lead to the appearance of backflows and stagnation regions...
March 6, 2018: Artificial Organs
Melanie E Fields, Kristin P Guilliams, Dustin K Ragan, Michael M Binkley, Cihat Eldeniz, Yasheng Chen, Monica L Hulbert, Robert C McKinstry, Joshua S Shimony, Katie D Vo, Allan Doctor, Hongyu An, Andria L Ford, Jin-Moo Lee
OBJECTIVE: To determine mechanisms underlying regional vulnerability to infarction in sickle cell disease (SCD) by measuring voxel-wise cerebral blood flow (CBF), oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen utilization (CMRO2 ) in children with SCD. METHODS: Participants underwent brain MRIs to measure voxel-based CBF, OEF, and CMRO2 . An infarct heat map was created from an independent pediatric SCD cohort with silent infarcts and compared to prospectively obtained OEF maps...
March 2, 2018: Neurology
Mohamed Almuqbil, Michael J Rivkin, Masanori Takeoka, Edward Yang, Lance H Rodan
GLUT1 deficiency syndrome (GLUT1DS) is a well described neurometabolic disorder that results from impaired glucose transport into the central nervous system. GLUT1DS classically presents with infantile-onset epilepsy, progressive microcephaly, developmental delay, ataxia, dystonia, and spasticity, but a minority of patients may manifest with paroxysmal non-epileptic phenomena including hemiparesis (Wang et al., 2002). We report for the first time cerebral perfusion changes during an acute episode of hemiparesis in a 9 year old child with GLUT1DS...
February 19, 2018: European Journal of Paediatric Neurology: EJPN
O Bar-Yosef, D Greidinger, M Iskilova, R Hemi, T Tirosh, A Vardi
INTRODUCTION: Children undergoing cardiac surgery may suffer from brain injuries after surgery and develop neurological deficit. Early diagnosis of brain injury after surgery would enable early therapeutic interventions. The aim of the study is to test whether S100B can serve as a biomarker for brain injury after cardiac surgery. METHODS: Seventy-five patients were enrolled in the study. Serum S100B was collected at the beginning of the surgery, and 6, 12, 24 h after surgery...
February 27, 2018: Clinica Chimica Acta; International Journal of Clinical Chemistry
Sara C Tho-Calvi, Dominic Thompson, Dawn Saunders, Shakti Agrawal, Anna Basu, Manali Chitre, Gabriel Chow, Frances Gibbon, Anthony Hart, Krishnaraya Kamath Tallur, Fenella Kirkham, Rachel Kneen, Helen McCullagh, Leena Mewasingh, Grace Vassallo, Kayal Vijayakumar, Elizabeth Wraige, Tong Hong Yeo, Vijeya Ganesan
OBJECTIVE: To describe characteristics and course of a large UK cohort of children with moyamoya from multiple centers and examine prognostic predictors. METHODS: Retrospective review of case notes/radiology, with use of logistic regression to explore predictors of outcome. RESULTS: Eighty-eight children (median presentation age 5.1 years) were included. Thirty-six presented with arterial ischemic stroke (AIS) and 29 with TIA. Eighty had bilateral and 8 unilateral carotid circulation disease; 29 patients had posterior circulation involvement...
February 27, 2018: Neurology
Brittany L Ko, John H Unkel
Moyamoya disease (MMD) is a rare cerebrovascular disorder involving progressive constriction of the internal carotid artery and its branches. The disease has a particularly aggressive course in very young patients, and early surgical intervention is often necessary to prevent permanent neurological damage. MMD patients have an increased risk of stroke development, which may be provoked by pain or anxiety. Currently, no reports of pediatric patients with MMD exist in the dental literature. The purpose of this paper was to discuss the dental management of a two-year-old with moyamoya disease who presented with early childhood caries and dental fear, offering recommendations for dental providers with emphasis on stroke prevention, collaboration with the medical team, anesthesia considerations for patients with increased stroke risk, and the challenges to maintain the oral health of a patient undergoing complex medical treatment...
January 1, 2018: Pediatric Dentistry
Mardee Greenham, Anne L Gordon, Anna Cooper, Michael Ditchfield, Lee Coleman, Rod W Hunt, Mark T Mackay, Paul Monagle, Vicki Anderson
Pediatric stroke can result in long-term neurobehavioral impairments including cognitive, language, and motor deficits, all of which may disrupt the normal development of social skills. This study aimed to examine specific components of social function at 5-year poststroke at a group and individual level and explore the contribution of neurobehavioral impairment. Thirty-one children with arterial ischemic stroke participated in the study. Assessment included parent-rated questionnaires measuring social adjustment and social participation as well as behavior and fatigue...
February 26, 2018: Developmental Neuropsychology
Ryan A Orizondo, Guy Gino, Garret Sultzbach, Shalv P Madhani, Brian J Frankowski, William J Federspiel
Gas transfer through hollow fiber membranes (HFMs) can be increased via fiber oscillation. Prior work, however, does not directly translate to present-day, full-scale artificial lungs. This in vitro study characterized the effects of HFM oscillations on oxygenation and hemolysis for a pediatric-sized HFM bundle. Effects of oscillation stroke length (2-10 mm) and frequency (1-25 Hz) on oxygen transfer were measured according to established standards. The normalized index of hemolysis was measured for select conditions...
February 20, 2018: Annals of Biomedical Engineering
Kevin Johnson, Marcus D Jarboe, George B Mychaliska, Ryan P Barbaro, Peter Rycus, Ronald B Hirschl, Samir K Gadepalli
BACKGROUND: Neurologic complications are common, and amongst the most devastating complications in pediatric patients undergoing extracorporeal life support (ECLS). Carotid artery cannulation (CAN) has been associated with an increase in these complications, thereby shaping practices to avoid this approach in most pediatric patients in which other cannulation approaches are viable. METHODS: A retrospective review of children (0-18years) in the ELSO database was undertaken from 1989 through 2013...
January 31, 2018: Journal of Pediatric Surgery
Andrea Fiume, Gabrielle Deveber, Shu-Hyun Jang, Colleen Fuller, Shani Viner, Sharon Friefeld
AIM: To develop and validate a disease-specific parent proxy and child quality of life (QoL) measure for patients aged 2 to 18 years surviving cerebral sinovenous thrombosis (CSVT) and arterial ischaemic stroke (AIS). METHOD: Utilizing qualitative and quantitative methods, we developed a 75-item Pediatric Stroke Quality of Life Measure (PSQLM) questionnaire. We mailed the PSQLM and a standardized generic QoL measure, Pediatric Quality of Life Inventory (PedsQL), to 353 families...
February 16, 2018: Developmental Medicine and Child Neurology
Mark S Wainwright
PURPOSE OF REVIEW: All critical care is directed at maintaining brain health, but recognizing neurologic complications of critical illness in children is difficult, and limited data exist to guide practice. This article discusses an approach to the recognition and management of seizures, stroke, and cardiac arrest as complications of other critical illnesses in the pediatric intensive care unit. RECENT FINDINGS: Convulsive and nonconvulsive seizures occur frequently in children after cardiac arrest or traumatic brain injury and during extracorporeal membrane oxygenation...
February 2018: Continuum: Lifelong Learning in Neurology
Catherine Amlie-Lefond
PURPOSE OF REVIEW: This article provides an overview of stroke in neonates, infants, and children. RECENT FINDINGS: Arterial ischemic stroke and cerebral venous sinus thrombosis are increasingly recognized in childhood as important causes of lifelong morbidity and mortality. Diagnosis of arterial ischemic stroke is frequently delayed, as acute neurologic deficits can be challenging to detect in the young child, and stroke is often not considered in the differential diagnosis...
February 2018: Continuum: Lifelong Learning in Neurology
Riten Kumar, Joseph Stanek, Susan Creary, Amy Dunn, Sarah H O'Brien
A hypercoagulable state resulting in increased venous thromboembolism (VTE) has been described in adults with sickle cell disease (SCD), but similar data for children are lacking. The objective of this retrospective cohort study was to describe the rate of VTE and risk factors associated with VTE in children with SCD across tertiary-care children's hospitals in the United States between the years 2009 and 2015. We used the Pediatric Health Information System database to investigate all pediatric patients with SCD admitted to 1 of 48 participating institutions between 1 January 2009 and 30 September 2015...
February 13, 2018: Blood Advances
Amy M DeLaroche, Lalitha Sivaswamy, Ahmad Farooqi, Nirupama Kannikeswaran
BACKGROUND: Acute stroke protocols improve delivery of care but it is unclear whether these resource intensive protocols are able to differentiate stroke from mimics in children. The aim of this study is to describe our institution's experience with stroke mimics identified through our pediatric stroke clinical pathway (PSCP). METHODS: The PSCP was implemented in our level 1 pediatric emergency department in June 2014 for children aged one month to 18 years. For patients managed using the PSCP from June 2014 to December 2016, demographic and clinical data were compared for patients diagnosed with stroke or a stroke mimic...
October 31, 2017: Pediatric Neurology
Kavelin Rumalla, Vijay Letchuman, Kyle A Smith, Paul M Arnold
BACKGROUND: Hydrocephalus is a life-threatening sequela of traumatic brain injury (TBI) with poorly defined epidemiology in children. Here, we report the national incidence, risk factors, and outcomes associated with post-traumatic hydrocephalus (PTH). METHODS: The Kids Inpatient Database (2003, 2006, 2009, 2012) was queried using the International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes to identify all patients (age 0 to 20) with TBI (850...
December 11, 2017: Pediatric Neurology
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