Incidence Of Neurological Sequelae Research Articles

Etiologies and clinical characteristics of acute ataxia in a single national children's medical center

ObjectiveTo analyze etiologic factors of pediatric acute ataxia and to identify the severity of its underlying causes for urgent medical intervention. MethodsClinical data of children diagnosed with acute ataxia between December 2015 and December 2021 from one national medical center were analyzed retrospectively. ResultsA total of 99 children (59 boys, 40 girls), median age at disease onset 55 (range: 12–168) months, were enrolled. The median follow period was 46 (range 6–78) months. Eighty-six (86.9 %) children were diagnosed with immune-associated acute ataxia, among which acute post-infectious cerebellar ataxia (APCA) was the most common diagnosis (50.5 %), followed by demyelinating diseases of the central nervous system (18.2 %) and Guillain-Barré syndrome (9.1 %). On cerebrospinal fluid (CSF) examination, 35/73 (47.9 %) patients had pleocytosis (>5 cells/mm3), and 18/73 (24.7 %) had elevated protein levels. Thirty-one patients (31.3 %) had an abnormal cerebral MRI. Children with other immune-associated acute cerebellar ataxia had more extracerebellar symptoms, intracranial MRI lesions, abnormal CSF results, longer hospital stay, higher recurrence rates and incidence of neurological sequelae than children with APCA. ConclusionImmune-associated acute ataxia is the main cause of pediatric acute ataxia, among which APCA is the most common phenotype. However, some immune-associated diseases, especially autoantibody-mediated disease, which has a higher recurrence rate and neurological sequelae account for an increasing proportion of pediatric acute ataxia. When children present with extracerebellar symptoms, abnormal cranial MRI or CSF results, and without prodromal infection, prudent differential diagnosis is recommended.

Application Analysis of Accompanying Nursing Mode Combined with Health Education in Hyperbaric Oxygen Therapy for Infants with Hypoxic Ischemic Encephalopathy

To study application effect of accompanying nursing mode and health education on infants with hypoxic ischemic encephalopathy (HIE) treated with hyperbaric oxygen therapy (HBOT) via pure oxygen chamber. 124 cases of HIE infants treated with pure oxygen chamberHBOT admitted to our department (December 2018-December 2019) were chosen as the research samples, and split into experimental group and control group according to the order of admission, with 62 cases in each group. The control group received routine nursing while and the experimental group received accompanying nursing mode combined with health education to compare the mental development index (MDI), psychomotor development index (PDI), height, weight, neurological sequelae, efficacy and family members’ satisfaction with HBOT between the two groups. After nursing, MDI and PDI in experimental group were obviously higher compared with control group (P<0.001);After nursing, the height and weight indexes in experimental group were obviously higher compared with control group (P<0.05);After nursing, the total incidence of neurological sequelae in experimental group (3.2%) was obviously lower compared with control group (P<0.05);After nursing, the total number of effective infants in experimental group was obviously higher compared with control group (P<0.05);After nursing, the number of family members satisfied with HBOT in experimental group was obviously higher compared with control group (P<0.05).The accompanying nursing mode combined with health education can greatly improve clinical indicators of HIE infants treated with pure oxygen chamber HBOT, promote their physical and mental development, and then improve the satisfaction of the family members with pure oxygen chamber HBOT, which should be promoted and applied in clinical practice as a high-quality nursing mode.

Perioperative Management of Pediatric Patients with Moyamoya Arteriopathy.

Pediatric patients with moyamoya arteriopathy are at high risk for developing new onset transient or permanent neurologic deficits secondary to cerebral hypoperfusion, particularly in the perioperative period. It is therefore essential to carefully manage these patients in a multidisciplinary, coordinated effort to reduce the risk of new permanent neurologic deficits. However, little has been published on perioperative management of pediatric patients with moyamoya, particularly in the early postoperative period during intensive care unit admission. Our pediatric neurocritical care team sought to create a multidisciplinary periprocedural evidence- and consensus-based care pathway for high-risk pediatric patients with moyamoya arteriopathy undergoing anesthesia for any reason to decrease the incidence of periprocedural stroke or transient ischemic attack (TIA). We reviewed the literature to identify risk factors associated with perioperative stroke or TIA among patients with moyamoya and to gather data supporting specific perioperative management strategies. A multidisciplinary team from pediatric anesthesia, neurocritical care, nursing, child life, neurosurgery, interventional neuroradiology, neurology, and hematology created a care pathway for children with moyamoya undergoing anesthesia, classifying them as either high or standard risk, and applying an individualized perioperative management plan to high-risk patients. The incidence of neurologic sequelae before and after pathway implementation will be compared in future studies.

The "Fortilat" Randomized Clinical Trial Follow-Up: Neurodevelopmental Outcome at 18 Months of Age.

Adequate nutrition is fundamental to neonatal survival and short-term outcomes, but it also has long-term consequences on quality of life and neurologic development of preterm infants. Donkey milk has been suggested as a valid alternative for children allergic to cows’ milk proteins, due to its biochemical similarity to human milk; we, hence, hypothesized that donkey milk could be a suitable basis for developing an innovative human milk fortifier for feeding preterm infants. The aim of the current study was to extend the findings and to evaluate the neurodevelopmental outcomes at 18 months of corrected age of the infants enrolled in the clinical trial named “Fortilat”. Infants born ≤1500 g and <32 weeks of gestational age were randomized to receive either a combination of bovine milk-based multicomponent fortifier and protein supplement or a combination of a novel multicomponent fortifier and protein supplement derived from donkey milk. The followed fortification protocol was the same for the two groups and the two diets were designed to be isoproteic and isocaloric. All infants enrolled were included in a developmental assessment program. The neurodevelopmental assessment was performed at 18 ± 6 months of corrected age. Minor and major neurodevelopmental impairment and General Quotient (GQ) at the Griffiths-II Mental Development Scale were considered. The GQ was considered both in continuous and as two classes: lower than and higher than (or equal to) a defined cutoff (GQcl). The difference in GQ and GQcl between the two arms was estimated using Mann–Whitney–Wilcoxon test or Fischer exact test, respectively, on the assumption of casual loss at follow-up. A further analysis was performed using generalized linear models. There were 103 children (bovine milk-derived fortifier arm = 54, donkey milk-derived fortifier arm = 49) included for the neurodevelopmental follow-up. All observations were included in the interval of 18 ± 6 months of corrected age. No significant difference was observed between the two arms in the incidence of neurologic sequelae and the GQs were similar in the two arms. Our results demonstrated no difference for the donkey milk-derived fortifier compared to standard bovine-derived fortifier regarding long-term neurodevelopmental outcomes.

Sturge-Weber Syndrome: A Boy with Port-wine Stain and Seizure

Neurocutaneous disorders are a heterogeneous group of genetic disorders that include Sturge-Weber syndrome (SWS), which is characterized by congenital capillary-venous malformation manifesting as port-wine stain, leptomeningeal angiomatosis and ocular angiomas. Diagnosis is made when at least two of these three areas are involved. Abnormal vessels lead to stasis and congestion resulting in decreased regional perfusion and eventually cause hypoxic brain injury with neuronal loss and gliosis. Seizures are common neurological manifestation in SWS patients and many patients have intractable seizures, eventually leading to motor deficits or developmental and cognitive delays. Here we report a case of a 16-year-old boy who presented with typical port-wine stain and seizure disorder since childhood. Neuroimaging revealed evidence of cerebral vascular malformation ipsilateral to the cutaneous lesion. Seizure was controlled with antiepileptic drugs. Early diagnosis and prompt treatment may reduce the incidence of neurologic sequelae. Proper counselling is necessary to improve compliance.

Meta-analysis evaluation of the treatment of neonatal hypoxic-ischemic encephalopathy with ganglioside

To evaluate the efficacy and safety of ganglioside in the treatment of neonates who suffer from hypoxic-ischemic encephalopathy(HIE). To research the databases of PubMed, ScienceDirect, LISTA, CNKI, Chinese biomedical literature database, Wanfang digital journals of full-text database, then to determine the inclusion and exclusion criteria and conduct the Meta-analysis with RevMan5.0 software after quality evaluation of literatures. A total of 12 papers were included, the results of Meta-analysis showed that compared with the control group, the abnormal rate declined in the ganglioside-treat group(relative risk(RR)=0.27, 95% confidence interval (CI)= 0.05-1.96)NBNA records of the 7d,10-14d improved effectively with the RR (95%CI) were 2.28(0.86-3.42), 2.53(1.04-2.92)respectively. neural system sequelae incidence is reduced significantly(RR=0.35, 95%CI: 0.15-0.79). Ganglioside treatment could reduce the head CT abnormality rate effectively , improve the neurological score, reduce the incidence of neurological sequelae, and prompt clinical recovery significantly for neonates with HIE when compared with the control group.

Resuscitation thoracotomy

Resuscitation thoracotomy is a rarely performed procedure whose use, in France, remains marginal. It has five specific goals that correspond point-by-point to the causes of traumatic cardiac arrest: decompression of pericardial tamponade, control of cardiac hemorrhage, performance of internal cardiac massage, cross-clamping of the descending thoracic aorta, and control of lung injuries and other intra-thoracic hemorrhage. This approach is part of an overall Damage Control strategy, with a targeted operating time of less than 60minutes. It is indicated for patients with cardiac arrest after penetrating thoracic trauma if the duration of cardio-pulmonary ressuscitation (CPR) is <15minutes, or <10minutes in case of closed trauma, and for patients with refractory shock with systolic blood pressure <65mm Hg. The overall survival rate is 12% with a 12% incidence of neurological sequelae. Survival in case of penetrating trauma is 10%, but as high as 20% in case of stab wounds, and only 6% in case of closed trauma. As long as the above-mentioned indications are observed, resuscitation thoracotomy is fully justified in the event of an afflux of injured victims of terrorist attacks.

Intrathecal Bleed Following Percutaneous Spinal Cord Stimulator Trial Lead Placement

An intrathecal bleed is an exceedingly rare, yet potentially devastating consequence of accessing the epidural space for lead placement during a spinal cord stimulator trial. We present a case of radiologic evidence of intrathecal blood products and the neurologic consequences thereof following a percutaneous spinal cord stimulator trial. A 34-year-old man with a primary diagnosis of failed back surgery syndrome underwent percutaneous spinal cord stimulator lead placement. During the trial, the patient experienced paresthesia with initial right-side lead placement at T12-L1. The lead and needle were removed and placed at L1-2 where the patient did not report any problems. The patient reported right calf pain in the postanesthesia care unit following the trial that improved with intravenous hydromorphone. However, following discharge the patient experienced worsening dysesthesia with edema of the right lower extremity to the calf. Magnetic resonance imaging of the lumbar spine confirmed the presence of blood products within the intrathecal space. Spinal cord stimulator placement may be viewed as a safe and effective treatment modality despite the incidence of several neurologic, mechanical, and biologic complications. A few case reports discuss the occurrence of spinal epidural hematoma formation but none present a case of an intrathecal bleed following percutaneous spinal cord stimulator lead placement. This case report highlights the need to further elucidate the incidence of neurologic sequelae after spinal cord stimulator placement. Key words: Spinal cord stimulation, antiplatelets, anticoagulation, intrathecal bleed, complications, failed back surgery syndrome

Clinical hypoxic-ischemic encephalopathy score of the Iberoamerican Society of Neonatology (Siben): A new proposal for diagnosis and management

Hypoxic ischemic encephalopathy is a major complication of perinatal asphyxia, with high morbidity, mortality and neurologic sequelae as cerebral palsy, mostly in poor or developing countries. The difficulty in the diagnosis and management of newborns in these countries is astonishing, thus resulting in unreliable data on this pathology and bad outcomes regarding mortality and incidence of neurologic sequelae. The objective of this article is to present a new clinical diagnostic score to be started in the delivery room and to guide the therapeutic approach, in order to improve these results.

Synergistic induction of CXCL10 by interferon-gamma and lymphotoxin-alpha in astrocytes: Possible role in cerebral malaria

Cerebral malaria (CM) has a high mortality rate and incidence of neurological sequelae in survivors. Hypoxia and cytokine expression in the brain are two mechanisms thought to contribute to the pathogenesis of CM. The cytokines interferon (IFN)-γ and lymphotoxin (LT)-α and the chemokine CXCL10 are essential for the development of CM in a mouse model. Furthermore, serum IFN-γ protein levels are higher in human CM than in controls, and CXCL10 is elevated in both serum and cerebrospinal fluid in Ghanaian paediatric CM cases. Astrocytes actively participate in CNS pathologies, becoming activated in response to various stimuli including cytokines. Astrocyte activation also occurs in murine and human CM. We here determined the responsiveness of mouse and human astrocytes to IFN-γ and LT-α, with the aim of further elucidating the role of astrocytes in CM pathogenesis. Initially we confirmed that Ifn-γ and Cxcl10 are expressed in the brain in murine CM, and that the increased Cxcl10 expression is IFN-γ-dependant. IFN-γ induced CXCL10 production in human and murine astrocytes in vitro. The degree of induction was increased synergistically in the presence of LT-α. IFN-γ induced the expression of receptors for LT-α, while LT-α increased the expression of the receptor for IFN-γ, in the astrocytes. This cross-induction may explain the synergistic effect of the two cytokines on CXCL10 production. Expression of these receptors also was upregulated in the brain in murine CM. The results suggest that astrocytes contribute to CM pathogenesis by producing CXCL10 in response to IFN-γ and LT-α.

Benzodiazepines induce sequelae in immature mice with inflammation-induced status epilepticus.

Since benzodiazepines (BZPs) became clinically available for the treatment of status epilepticus (SE) in children, the incidence of neurological sequelae has increased. However, the cause-effect relationship is poorly understood. In this paper, we examined the effect of BZPs on an inflammation-induced SE (iSE) animal model. Inflammation was induced by injecting poly(I:C) (pIC 10 mg/kg, postnatal day 12-14), seizure was induced by injecting pilocarpine hydrochloride (PILO 200 mg/kg, postnatal day 15) into C57BL/6J mice, and the pIC+PILO mice were used as the iSE model (miSE). The GABA-A receptor agonist midazolam (MDL 0.5 mg/kg) was used to inhibit seizures. Sequelae were evaluated by performing behavior and immunohistochemical analyses in the chronic phase. The exploratory activity of mice in the miSE plus MDL group increased significantly, indicating that hyperactivity was newly induced by MDL in miSE mice. The contextual fear memory of the miSE mice was also significantly increased and that of miSE treated with MDL returned to the normal level. The parvalbumin-positive GABA neurons were decreased in number by pIC+PILO which was rescued by MDL. Apoptosis marker ssDNA-positive cells were increased by pIC+PILO which could not be rescued by MDL. Therefore, we propose that BZP-dependent therapy for SE needs to be rethought from the perspective of using other treatment approaches.

Therapeutic success in a case of anaerobic sepsis with multiple brain abscesses in the context of an efficient interdisciplinary cooperation

Background Brain abscess is one of the most serious complications of head infections, with significant case-fatality rates. Great progress was made after introduction of antimicrobial therapy with improved microbiologic culture techniques, particularly for anaerobes, and stereotactic brain biopsy and aspiration techniques. The incidence of neurological sequelae in patients who survive a brain abscess is high.

Efficacy of Dextromethorphan and Cyclosporine A for Acute Encephalopathy

Acute encephalopathy with biphasic seizures and late reduced diffusion was recently established clinicoradiologically as an encephalopathy syndrome. The outcome of this encephalopathy is characterized by a low mortality rate and high incidence of neurologic sequelae. Although the exact pathogenesis of this encephalopathy is uncertain, excitotoxic injury with delayed neuronal death is proposed. On the basis of this hypothesis, we tried a combination therapy of N-methyl-D-aspartate receptor antagonist, dextromethorphan, and apoptosis inhibitor, cyclosporine A, in four patients with acute encephalopathy with biphasic seizures and late reduced diffusion. All patients recovered except for hyperactivity in one patient. Furthermore, an additional four patients with near-miss encephalopathy, who showed mild disturbance of consciousness at 24 hours after prolonged febrile seizures associated with exanthem subitum, recovered without secondary seizures by the early administration of dextromethorphan. The combination regimen of dextromethorphan and cyclosporine A could be effective for the treatment and prevention of acute encephalopathy with biphasic seizures and late reduced diffusion.

Extracranial infected carotid artery aneurysm

Infected aneurysms of the extracranial carotid arteries are rare. This is a case report of a 63-year-old female who developed an infected internal carotid artery aneurysm due to group B Streptococcus ten days after a dental procedure. She was successfully treated with excision of the aneurysm and common to internal carotid artery bypass with greater saphenous vein.

Neurological complications following functional neck dissection

A retrospective study was done to assess the incidence and factors associated with neurological complications in patients who have undergone a functional neck dissection (FND). Four hundred forty-two epidermoid cancer patients operated on from January 1984 to December 2002 were included in the study. Clinical parameters, neurological sequelae, and other complications were evaluated in all cases. The incidence of neural damage was calculated on the nerves at risk (n =714). Paralysis of the 11th nerve occurred in 12 cases (1.68%). A lesion of the marginal branch of the 7th cranial nerve was observed in nine cases (1.26%). Bernard-Horner's syndrome and hypoglossal nerve paralysis were noted in four and three cases (0.56 and 0.42%), respectively. Thus, the incidence of neurological sequelae after FND is low. Neurological complications were not associated with either clinical parameters or non-neurological complications (P >0.05). None of the factors studied can predict the appearance of neural problems in the postoperative period.

Neurological complications following regional anaesthesia in obstetrics

Neurological complications may complicate regional anaesthesia. The incidence has been reported as 0–36 per 10 000 blocks after epidural anaesthesia and 35 per 10 000 blocks after spinal anaesthesia. The most common complication is a reversible neuropathy due to direct needle/catheter trauma or intraneural injection of local anaesthetic presenting as a radiculopathy involving a single spinal nerve root. In a prospective study of over 10 000 obstetric epidural anaesthetics, there were problems with insertion in 13% of cases. The only neurological sequelae reported was one case of neuropathy. A retrospective postal survey in the UK reported a total of 56 cases of prolonged neurological sequelae following spinal or combined spinal-epidural anaesthetics, of which 18 could be attributed to the regional procedure, 29 were of uncertain origin and 9 could be attributed to other factors. The incidence of neurological sequelae in this study was estimated as being around 1 in 1000. It is recognised that under-reporting may occur and the situation is complicated in that neurological dysfunction may also occur co-incidentally or in association with the process of childbirth. Indeed, transient neurological dysfunction in the postpartum period occurs in up to 20% of women, although this is only clinically important in 1 in 500. Any neurological complication in the postpartum period (Table 1) requires careful assessment and, in the majority of cases, reassurance and explanation is all that will be needed. Occasionally, urgent investigation and treatment is required in consultation with a neurologist. Post-dural puncture headache and its differential diagnosis has been discussed recently in this journal (see key references) and will not be considered further.

Avaliação da idade gestacional de recém-nascidos pré-termo através do exame neurológico e das escalas neonatais e obstétrica

Perinatal mortality and the incidence of neurological sequelae in preterm infants have diminished owing to advances in perinatology. The accurate assessment of gestational age is a very important component of the medical practice and for the newborn's management. Herein we provide a study to evaluate the neurological examination in comparison to the obstetrics dating criteria and pediatrics scales (Dubowitz and Capurro) to determine the gestational age as well as to compare the gestational age obtained with the different methods. We studied 35 preterm newborns leaving out those ones with any pathologies. The different scales to determine the gestational age were administered to each infant, beyond the neurological examination. We conclude that André-Thomas method is an appropriate clinical tool for reliable determining for gestational age in preterm newborns.

Factores de riesgo predictivos de secuelas neurológicas en recién nacidos a término con asfixia perinatal

Perinatal asphyxia (PA) and its neurologic manifestations are the most important cause of brain injury and neurologic sequelae in full-term infants. The objective of this study is to analyze the perinatal risk factors of neurologic sequelae in asphyctic term newborns. One hundred and fifty-six consecutive asphyctic term infants were studied prospectively during 40 months. PA was graded in two stages (severe and non-severe), hypoxic-ischemic encephalopathy classification was based on Levene's criteria, and neurologic sequelae was based on Finer and Amiel-Tisson's criteria. The perinatal variables were graded as prenatal (gestational and obstetrics), neonatal (resuscitation, general data of the newborn, and organic manifestations of asphyxia) and postneonatal (neurologic sequelae with at least 24 months of follow-up). The relationships between these variables are studied by univariant and multivariant analysis (Cox's regression). PA was graded as severe in 31 cases and non-severe in 125. Neurologic manifestations (hypoxic-ischemic encephalopathy) during neonatal period were present in 25.6%, and extraneurologic manifestations (hypoxic-ischemic disease) in 41.7% cases. The incidence of neurologic sequelae, in 115 asphyxiated full-term infants follow-up at least 24 months, was 16.5% (19 cases). The perinatal variables associated to risk of neurologic sequelae on univariate analysis are variables of neonatal resuscitation (1 minute Apgar score < or = 4, 5 minute Apgar score < or = 6, endotracheal intubation, severity of PA) and variables of systemic manifestations (hypoxic-ischemic encephalopathy, cardiovascular and multi-systemic dysfunction, and mechanical ventilation). But only two variables are independently associated on multivariate analysis: severe PA (RR = 2.82; IC = 1.07-7.39) and hypoxic-ischemic encephalopathy (RR = 4.17; IC = 1.48-11.75). The best predictive risk factors for the neurological prognosis at follow-up are severe PA at birth and/or evidence of encephalopathy in neonatal period.

Evolución neurológica de los recién nacidos a término asfícticos con acidosis umbilical grave (pHAU £7,00)

Umbilical arterial blood pH (pHUA) has become increasingly recognized as the most reliable indication of foetal oxygenation and acid-base condition at birth. In term infants pHUA is a poor predictor of newborn complications associated with perinatal asphyxia (PA), unless the pHUA is less than 7.00. The objective of this article is to analyse the neurologic evolution of asphyctic full-term newborns with severe umbilical acidosis (pHUA < or = 7.00). One hundred and eighty consecutive asphyxiated term infants were studied during 64 months, and classified in two cohorts: G1 (pHUA < or = 7.00, n = 18) and G2 (pHUA > 7.00, n = 162). Variables prospectively obtained on standard protocol forms from the medical records were derived from a detailed review of the obstetric record, the delivery room management, the detailed neonatal clinical history and the postneonatal follow-up. The perinatal variables were graded as prenatal (gestational and obstetric), neonatal (resuscitation, general data of the newborn, and organic manifestations of asphyxia) and postneonatal (neurologic sequelae with at lest 24 months of follow-up). PA was graded as severe and non-severe, hypoxic-ischemic encephalopathy was based on Levene's criteria, and neurologic sequelae were based on Finer and Amiel-Tisson's criteria. An umbilical artery pH value < or = 7.00 occurred in 0.3% of the total live full-term newborns. In G1 the mean pHUA value was 6.93 +/- 0.06 (range 6.80-7.00) and in G2 the mean pHUA value was 7.17 +/- 0.09 (range 7.01-7.46). The incidence of severe PA was significantly increased in G1 (RR = 4.74, CI 95% = 2.62-8.55, p < 0.001), with more postasphyctic neurologic (RR = 3.72, CI 95% = 2.34-5.92, p < 0.001) and extraneurologic (RR = 3.13, CI 95% = 1.65-5.94, p < 0.01) involvement. But we do not found differences in the incidence of neurologic sequelae between both cohorts. Term asphyctic newborns with severe umbilical acidosis have worse evolution at short term (more clinical involvement during neonatal period), but not worse evolution at long term (neurologic sequelae). The poor correlation between umbilical acidosis and neurologic prognosis persist when pHUA cut-off is < or = 7.00.

Neurological outcome of methylmalonic acidaemia

OBJECTIVETo assess the long term outcome of patients with methylmalonic acidaemia in a cross sectional study.PATIENTSAll 35 patients with methylmalonic acidaemia seen at Great Ormond Street Hospital for Children in...