Pediatric neurology
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Chiari I malformation is characterized by downward herniation of the cerebellar tonsils through the foramen magnum. Scant data are available on the clinical course, relationship to the extent of herniation on magnetic resonance imaging in Chiari I malformation and the presence of sleep-disordered breathing on polysomnography. Retrospective analysis was performed looking at polysomnographic findings of children diagnosed with Chiari I malformation. ⋯ Children with sleep-disordered breathing had excessive crowding of the brainstem structures at the foramen magnum and were more likely to have a greater length of herniation compared with those children without sleep-disordered breathing (P = 0.046). Patients with central sleep apneas received surgical decompression, and their conditions were significantly improved on follow-up polysomnography. These data suggest that imaging parameters may correlate with the presence of sleep-disordered breathing in children with Chiari I malformation.
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Pediatric neurology · Apr 2013
Adherence to quality measures in a pediatric epilepsy center: a pilot study.
A retrospective study was conducted to determine compliance with the American Academy of Neurology quality measures for epilepsy care in a single tertiary care pediatric epilepsy clinic. Paper and electronic charts of children 0 to 20 years of age, with an established diagnosis of epilepsy, who receive their medical care at the Children's Hospital of Michigan in Detroit, were reviewed. ⋯ The quality measures where greatest adherence was demonstrated were ordering and review of electroencephalogram results at clinic visits and documentation of frequency of seizures. Practitioner education, use of electronic checklists, and an automated tracking system may enhance compliance and ultimately lead to superior patient care.
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Pediatric neurology · Apr 2013
Therapeutic hypothermia associated with increased survival after resuscitation in children.
Brain injury after resuscitation is associated with high morbidity and mortality in children. Therapeutic hypothermia has theoretical benefits on brain preservation. It has been shown to be effective in improving neurological outcomes after adult ventricular arrhythmia-induced cardiac arrest and neonatal asphyxia. ⋯ Fourteen (33.3%) patients received hypothermia therapy and were cooled to 33°C for 72 hours. The survival rate was higher in the therapeutic hypothermia group (11/14, 78.6%) than in the normothermia group (13/28, 46.4%). In conclusion, therapeutic hypothermia was associated with increased survival rate after pediatric resuscitation.