Seminars in pediatric neurology
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Medical futility concerns itself with decisions regarding treatments that are of minimal potential benefit to the patient. The concept of futility has evolved with the practice of medicine and consensus has been elusive. ⋯ Though frequently intermixed, futility and rationing are separate matters, with futility reflecting individual decisions taken at the bedside, whereas rationing represents decisions of publicly determined health policy. Objective, uniformly applicable guidelines regarding futility will likely be difficult to achieve and thus local efforts must be focused on implementing mechanisms to minimize and resolve inevitable disputes between patients, families, and caregivers.
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Surgery for intractable epilepsy is being offered at progressively younger ages, including infancy. The most common causes of catastrophic epilepsy in very young surgical candidates are focal malformations of cortical development and low-grade tumors. Additional causes include Sturge-Weber syndrome, epidermal nevus syndrome, hemimegalencephaly, and prenatal or perinatal infarction. ⋯ Most infant candidates for epilepsy surgery have significant developmental delay. Few data are available, but anecdotal experience suggests that surgical relief of catastrophic epilepsy may result in resumption of developmental progression. For each infant, the timing of surgery must be carefully considered based on full assessment of the relative risks and benefits, derived from a detailed presurgical evaluation.
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Semin Pediatr Neurol · Mar 2000
ReviewImproving shoulder and elbow function in children with Erb's palsy.
Many children who sustain birth injuries to the brachial plexus suffer significant functional limitations due to various sequelae affecting the shoulder and elbow or forearm. The maintenance of full passive mobility during the period of neurological recovery is essential for normal joint development. ⋯ Reconstruction of forearm rotation contractures significantly improves the appearance and use of the extremity for many basic activities. Each child must be carefully evaluated, therapy maximized, and the surgical approach individualized to obtain the best result.
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Focal upper extremity neuropathies are common in neonates. The brachial plexus is the most common site involved. Brachial plexus injuries may involve different structures, thus producing different clinical presentations: complete brachial plexus palsy, Duchenne-Erb palsy, upper-middle trunk brachial plexus palsy, Klumpke palsy, fascicular brachial plexus palsy, and bilateral brachial plexus palsy. ⋯ The differential diagnosis of brachial plexus palsy includes pseudoparesis, amyoplasia congenita, congenita varicella syndrome, and neurological lesions at other neuroanatomical levels. The cause and the degree of injury dictate the prognosis. The prognosis of obstetric brachial plexus injury is usually good.
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Semin Pediatr Neurol · Dec 1999
ReviewNeuroimaging of postnatal pediatric central nervous system infections.
Pediatric neuroimaging plays an important role in the timely diagnosis of postnatal central nervous system (CNS) infections, and in some patients the imaging findings are sufficiently specific to suggest a cause. The sequela of CNS infection, including hydrocephalus, subdural collections, ischemia/infarction, cerebral abscess, demyelination, and vascular thrombosis, can be accurately depicted and serially followed with current imaging techniques. The purpose of this review is to describe the spectrum of pediatric postnatal CNS infections, emphasizing key pathological and neuroimaging features, and to outline the strengths, weaknesses, and applications of current neuroimaging technology. The prenatal and perinatal infections falling under the designation of TORCH (toxoplasmosis, other [e.g., syphilis, HIV], rubella, cytomegalovirus, and herpes simplex II) are not covered.