Neuromonitoring in Children with Cerebrovascular Disorders
Dana B Harrar1, Lisa R Sun2, J Bradley Segal3
1Division of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA. dharrar@childrensnational.org.
Insights
Neuromonitoring advances aid acute care for pediatric cerebrovascular disorders like stroke and venous thrombosis. These tools help identify evolving injuries and guide real-time treatment adjustments for better outcomes.
Area of Science:
- Pediatric neurology and critical care medicine.
- Cerebrovascular diseases in children.
- Neurocritical care and neuromonitoring techniques.
Background:
- Cerebrovascular disorders are a significant cause of child morbidity and mortality.
- Acute care focuses on stabilization, etiology, and secondary injury prevention.
- This review examines neuromonitoring in pediatric stroke and cerebral sinus venous thrombosis.
Approach:
- Narrative review of existing literature.
- Focus on invasive and noninvasive neuromonitoring modalities.
- Analysis of neuromonitoring's role in acute pediatric cerebrovascular events.
Key Points:
- Neuroimaging, NIRS, TCD, EEG, ICP monitoring, and multimodal neuromonitoring enhance care.
- Neuromonitoring aids early detection of infarct expansion, hemorrhage, vasospasm, seizures, and hypertension.
- Facilitates real-time treatment adjustments for improved patient management.
Conclusions:
- Advances in neuromonitoring have significantly improved understanding of pediatric cerebrovascular disorders.
- Neuromonitoring capabilities are poised to optimize management and treatment strategies.
- Further integration of neuromonitoring is crucial for advancing pediatric neurocritical care.
Background:
Cerebrovascular disorders are an important cause of morbidity and mortality in children. The acute care of a child with an ischemic or hemorrhagic stroke or cerebral sinus venous thrombosis focuses on stabilizing the patient, determining the cause of the insult, and preventing secondary injury. Here, we review the use of both invasive and noninvasive neuromonitoring modalities in the care of pediatric patients with arterial ischemic stroke, nontraumatic intracranial hemorrhage, and cerebral sinus venous thrombosis.
Methods:
Narrative review of the literature on neuromonitoring in children with cerebrovascular disorders.
Results:
Neuroimaging, near-infrared spectroscopy, transcranial Doppler ultrasonography, continuous and quantitative electroencephalography, invasive intracranial pressure monitoring, and multimodal neuromonitoring may augment the acute care of children with cerebrovascular disorders. Neuromonitoring can play an essential role in the early identification of evolving injury in the aftermath of arterial ischemic stroke, intracranial hemorrhage, or sinus venous thrombosis, including recurrent infarction or infarct expansion, new or recurrent hemorrhage, vasospasm and delayed cerebral ischemia, status epilepticus, and intracranial hypertension, among others, and this, is turn, can facilitate real-time adjustments to treatment plans.
Conclusions:
Our understanding of pediatric cerebrovascular disorders has increased dramatically over the past several years, in part due to advances in the neuromonitoring modalities that allow us to better understand these conditions. We are now poised, as a field, to take advantage of advances in neuromonitoring capabilities to determine how best to manage and treat acute cerebrovascular disorders in children.
