Cause Of Neurological Deterioration Research Articles

Morbidity in neurologically impaired children after percutaneous endoscopic versus Stamm gastrostomy

Neurologically impaired children frequently require a feeding gastrostomy. Few reports are available comparing the incidence of postoperative complications and symptomatic gastroesophageal reflux after endoscopic versus operative Stamm gastrostomy in this group of children. We undertook a retrospective study of 63 consecutive neurologically impaired children requiring a feeding gastrostomy, with an average of 23 months of follow-up. No child had symptomatic gastroesophageal reflux. Thirty children had a percutaneous endoscopic gastrostomy and 33 had a Stamm gastrostomy, depending on the preference of the surgeon. The two groups were comparable in age range, cause of neurologic impairment, and indication for gastrostomy. Minor complications occurred in 30%. All three major complications occurred after Stamm gastrostomy, including two postoperative deaths. Symptomatic gastroesophageal reflux developed in 60%. The incidence of fundoplication after gastrostomy was 10% in the percutaneous endoscopic gastrostomy group and 39% after Stamm gastrostomy ( p < .025). Morbidity was lower after percutaneous endoscopic gastrostomy than after Stamm gastrostomy in this group of neurologically impaired children. Fundoplication for symptomatic gastroesophageal reflux was infrequent after percutaneous endoscopic gastrostomy and significantly more common after Stamm gastrostomy. Percutaneous endoscopic gastrostomy is recommended as the initial procedure in neurologically impaired children without symptomatic gastroesophageal reflux who require a feeding gastrostomy. (Gastrointest Endosc 1995;42:41-4.)

Neuroimaging and functional outcome of neonatal leukomalacia

Leukomalacia is a major cause of neurological impairment in the high-risk newborn. It can be identified during the early postnatal period by means of ultrasound (US) imaging of the brain, through the anterior fontanel. Magnetic resonance imaging (MRI) permits an optimal differentiation of brain tissue and of its abnormalities, without resorting to ionizing radiation or intravenous contrast. It is particularly appropriate for following the evolution of leukomalacia, after fontanel closure. Ninety-five fullterm and preterm infants with cystic and non-cystic leukomalacia, documented by US, were clinically followed-up until at least 12 months of corrected age. Thirty-two had a severe neurological outcome (mainly cerebral palsy, sometimes associated with mental retardation and/or cerebral visual impairment). The prognosis was worse in cystic leukomalacia than in prolonged flare. Electroencephalogram (EEG) carried out in the first 2 weeks of life provided valuable indexes of further outcome, especially for US findings of more uncertain prognosis. MRI was carried out at around 12 months of corrected age, by means of an apparatus operating at 0.5 Tesla. The main categories of abnormalities observed were the following: cystic lesions, enlarged ventricles with irregular outlines, delayed myelination, high intensity areas in the long TR (repetition time) images within the white matter, cortical atrophy. MRI findings correlated well with the results of US imaging and often with motor, cognitive and visual impairments. Nevertheless, clinical features cannot be predicted by neuroimaging alone and a comprehensive approach, including longitudinal functional and electrophysiological testing, is highly recommended.

Postoperative Magnetic Resonance Imaging in Patients with Cervical Myelopathy

Magnetic resonance imaging using T1-weighted sagittal images was performed on 81 postoperative patients with cervical myelopathy. Cord compression was observed after surgery in 32 (40%) of the patients. Compression was demonstrated in the decompressed area in 9 patients, at the upper or lower edge of decompression in 11 patients, and at adjacent levels of fusion in 11 patients. The remaining patient had cord compression in both the decompressed area and at the adjacent level. From their operative results, cord compression was proved to be functionally innocuous in 13 (41%) patients and the cause of neurologic deterioration in 3 (9%); it was not clear whether or not the compression was innocuous in the remaining 16 (50%) patients.

The significance of the collateral vascular system of the brain in shunt and steal syndromes

Neurological deterioration can occur in 13–38% of patients with acute ischemic stroke due to hemodynamic and non-hemodynamic causes. Several non-hemodynamic mechanisms can lead to ischemic lesion extension and subsequent neurological worsening, including infections, cerebral edema, hemorrhagic conversion of infarction and metabolic disorders. The most common hemodynamic causes related to infarct expansion, leading to neurologic deterioration in the setting of acute cerebral ischemia are the following: (i) cardiac complications, (ii) arterial reocclusion, (iii) intracranial arterial steal phenomenon, and (iv) cerebral microembolization. The present review aims to address the underlying mechanisms and potential clinical implications of the hemodynamic causes of neurological deterioration in patients with acute cerebral ischemia. The contribution of neurosonology in detection of changes in cerebral hemodynamics in real-time are also going to be discussed. Finally, potential treatment strategies for specific causes of hemodynamic deterioration in acute ischemic stroke patients are reported.