Seminars in pediatric neurology
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Monitoring of central nervous system function in the intensive care unit is becoming more widely accepted as an integral part of critical care. The history of developments in electroencephalogram (EEG) technology is reviewed to better appreciate the rate of technological developments and their application to clinical practice. Basic concepts of digital EEG are reviewed. Principals of intensive care unit monitoring as they apply to clinical neurophysiological techniques are examined to better understand the goals for an "ideal central nervous system monitor." Some current advances and directions for future development in computerized EEG monitoring are discussed.
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Functional magnetic resonance imaging (fMRI) allows for the noninvasive mapping of the anatomical location of disparate functional brain activities. The means for carrying out fMRI involves the use of existing MR technology coupled with a special software image acquisition program or the use of a specially designed head coil. Thus far in pediatric neurology, fMRI has assisted in the presurgical localization of critical functions and the investigation of various developmental activities. The technique of fMRI, its applications in pediatric neuroscience, and future potential are outlined in this article.
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Semin Pediatr Neurol · Mar 1999
ReviewDevelopmental progress of children with congenital heart defects requiring open heart surgery.
Recent advances for infants requiring early open heart surgery have resulted in a dramatic decline in mortality and severe morbidity. The developmental progress of these new survivors is currently being defined. Causes contributing to brain injury are multifactorial, and may involve preoperative, intraoperative, and postoperative events. ⋯ Long-term follow-up studies indicate that subtle neurological deficits and global developmental lags are characteristic of this population. Overall, severe neurological sequelae are uncommon; however, mild to moderate developmental disabilities are prevalent. Functional limitations, academic achievements, and health-related quality of life are areas that deserve further attention.
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Semin Pediatr Neurol · Mar 1999
ReviewThe pursuit of effective neuroprotection during infant cardiac surgery.
Advances in infant cardiac surgery have resulted in a dramatic decline in mortality rates; however, neurological morbidity remains an important concern. The effectiveness of a number of interventional strategies to prevent or minimize brain injury during open heart surgery are currently being investigated. This article provides an overview of two approaches: (1) interventions to enhance intraoperative cerebral oxygenation so as to prevent hypoxic-ischemic insults, and (2) the application of cerebral rescue therapies to attenuate the cascade of brain injury. Infant cardiac surgery provides a controlled environment in which to apply these neuroprotective approaches, so as to optimize the quality of life of these vulnerable children.
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Neurological injury is a major and often debilitating complication of congenital heart disease and open-heart surgery. Paradoxically, the full impact of this complication has been underscored by the marked decrease in mortality and the rescue of infants with desperate and previously lethal heart conditions. ⋯ Inflammatory cascades have been implicated in the end-organ injury seen after cardiopulmonary bypass and might play a role in neurological dysfunction. These mechanisms are reviewed, with an emphasis on recent developments in our understanding of brain injury in this population.