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Management of pediatric central nervous system emergencies: a review for general radiologists
1Hospital Universitario Maternoinfantil Sant Joan de Dèu, Esplugues de Llobregat, Barcelona, España.
Insights
This review covers common pediatric central nervous system (CNS) emergencies, guiding appropriate neuroimaging selection for conditions like seizures and trauma to ensure accurate diagnosis while minimizing radiation exposure.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Emergency Medicine
Background:
- Acute neurological symptoms are common in pediatric emergencies, stemming from diverse causes like trauma, abuse, infections, and ischemia.
- Accurate and timely diagnosis is crucial for effective management of pediatric central nervous system (CNS) disorders.
Purpose of the Study:
- To review common and critical CNS diseases and disorders in pediatric emergencies.
- To discuss appropriate neuroimaging indications for various pediatric neurological conditions.
Main Methods:
- Literature review of common pediatric CNS emergencies.
- Analysis of neuroimaging modalities and their diagnostic utility.
- Discussion of age-specific considerations and differential diagnoses.
Main Results:
- Identification of key pediatric CNS emergencies requiring neuroimaging.
- Outline of diagnostic algorithms tailored to clinical presentation and age.
- Emphasis on recognizing typical lesion patterns for etiological diagnosis.
Conclusions:
- Selecting the optimal neuroimaging strategy is vital for pediatric neurological emergencies.
- Consideration of radiation sensitivity and sedation needs in pediatric patients is essential.
- Balancing diagnostic benefits against risks, including avoiding unnecessary imaging, is paramount.
Teaching Objectives:
To review the most common and most important diseases and disorders of the central nervous system (CNS) in pediatric emergencies, discussing the indications for different imaging tests in each context.
Discussion:
In pediatric patients, acute neurologic symptoms (seizures, deteriorating level of consciousness, focal neurologic deficits, etc.) can appear in diverse clinical situations (trauma, child abuse, meningoencephalitis, ischemia…). It is important to decide on the most appropriate neuroimaging diagnostic algorithm for each situation and age group, as well as to know the signs of the most typical lesions that help us in the etiological differential diagnosis. Pediatric patients' increased vulnerability to ionizing radiation and the possible need for sedation in studies that require more time are factors that should be taken into account when indicating an imaging test. It is essential to weigh the risks and benefits for the patient and to avoid unnecessary studies.
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