Seminars in pediatric neurology
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Headaches are an extremely common complaint encountered in the pediatric population. The headache history establishes the diagnosis in the vast majority and most importantly identifies features suggesting a secondary cause. The headache history outlined will aid in headache classification and screen for ominous causes. ⋯ Preventative treatment may be beneficial when headaches result in significant disability and impaired quality of life. The limited available evidence for prophylactic treatment options is reviewed. Research into pediatric headache prevention and management remains a priority given the potential lifelong morbidity associated with headache.
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Semin Pediatr Neurol · Dec 2005
ReviewDisorders of attention or learning in neurodevelopmental disorders.
Disorders of attention or learning commonly accompany neurodevelopmental disorders. The evaluation and diagnosis of these disorders is complex and does not always follow techniques used for typically developing children. These disorders are often underappreciated and inadequately addressed because they are overshadowed by the neurodevelopmental disorder. Nevertheless, failure to recognize, diagnose, and manage these disorders may result in unsuccessful community integration.
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Semin Pediatr Neurol · Mar 2005
ReviewThe treatment of cardiac causes of sudden death, syncope, and seizure.
The treatment for pediatric causes for sudden cardiac death can either be general and supportive or, in 2005, can be much more etiology specific. While antiarrhythmic therapy and activity restriction have been for years the mainstay of therapy, newer technologies such as radiofrequency ablation and automatic implantable cardioverter defibrillators (AICDs) are now more commonly applied for certain disease entities. ⋯ Further improvements in risk stratification will allow us to determine which patients are at greatest risk, so that aggressive treatment can be delivered to these subgroups. In the future, there may be gene-specific therapies and/or genetic modification.
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One of the main risks of craniosynostosis surgery is the possible need for an allogenic blood transfusion (ABT). Most patients are operated on in the first months of life, when physiological conditions are particularly sensitive to even limited blood losses. ⋯ We review recent preoperative (ie, erythropoietin administration), intraoperative (ie, acute normovolemic hemodilution, intraoperative blood salvage), and postoperative (ie, clinical monitoring, postoperative blood salvage) anesthesiologic procedures developed with this aim in mind. We also consider operative techniques and technical apparatus that reduce surgical invasiveness, particularly preoperative planning, age selection, and the role of endoscopic assistance and gradual distraction devices.
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Ethical issues in the critical care unit frequently arise in children with neurological problems. These ethical issues frequently challenge our medical management of such cases and can be quite problematic. This article reviews key ethical issues that may arise including informed consent, futility, justice/rationing, clinical research conduct and the severely compromised patient who is in either a permanent vegetative or minimally conscious state.