Neuromonitoring in Children with Cerebrovascular Disorders

Authors

Dana B. Harrar, Division of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA. dharrar@childrensnational.org.
Lisa R. Sun, Divisions of Pediatric Neurology and Vascular Neurology, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Bradley Segal, Division of Child Neurology, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.
Sarah Lee, Division of Child Neurology, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.
Arnold J. Sansevere, Division of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.

Document Type

Journal Article

Publication Date

2-24-2023

Journal

Neurocritical care

DOI

10.1007/s12028-023-01689-2

Keywords

Arterial ischemic stroke; Cerebral sinus venous thrombosis; Computerized tomography; Continuous electroencephalography; Digital subtraction angiography; Intracranial hemorrhage; Ischemia; Magnetic resonance imaging; Near-infrared spectroscopy; Quantitative electroencephalography; Transcranial Doppler ultrasonography

Abstract

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.

APA Citation

Harrar, Dana B.; Sun, Lisa R.; Segal, J Bradley; Lee, Sarah; and Sansevere, Arnold J., "Neuromonitoring in Children with Cerebrovascular Disorders" (2023). GW Authored Works. Paper 2361.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2361

Department

Neurology