scholarly journals Spectrum of Intracerebral Hemorrhage in Children: A Report from PICU of a Resource Limited Country

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Qalab Abbas ◽  
Qurat ul Ain Merchant ◽  
Bushra Nasir ◽  
Anwar ul Haque ◽  
Basit Salam ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Medical Records ◽  
Vascular Malformations ◽  
Pediatric Intensive Care ◽  
Conventional Angiography ◽  
Altered Level ◽  
Vascular Intervention ◽  
Resource Limited ◽  
Level Of Consciousness ◽  
Gender Presentation

Intracerebral hemorrhage (ICH) in children is a rare but disabling disease that accounts for almost half cases of stroke. We report our experience of ICH in children. Retrospective review of medical records of children (1 month-16 years) admitted in Pediatric Intensive Care Unit between January 2007 and December 2014 was done. Data collected included age, gender, presentation, examination findings, neuroimaging done (CT, MRI, and angiography) management (conservative/intervention), and outcome. Results are presented as frequency and percentages. Of the total 50 patients, 58% were male and 26% were <1 year. On presentation 44% had vomiting, 42% had seizures, and GCS < 8 while 40% had altered level of consciousness. Single bleed was present in 88%, 94% had supratentorial bleed, and 32% had intraventricular extension. 72% had bleed volume of <30 mL and 8% had >60 mL. CT scan was done in 98% patients and MRI in 34%, while 6% underwent conventional angiography. 60% patients were managed conservatively, 36% underwent neurosurgical intervention, and 6% underwent radiological vascular intervention. Hematologic causes were identified in 52% patients and vascular malformations in 14% and in 26% no cause could be identified. 26% of patients expired.

scholarly journals The Etiologies of Altered Level of Consciousness in the Emergency Department: Before versus after Coronavirus Disease-19

2021 ◽  
Vol 39 (3) ◽  
pp. 141-149
Author(s):  
Dong Hwan Kim ◽  
Jae Cheon Jeon ◽  
In-Cheol Kim ◽  
Yaerim Kim ◽  
Yong Won Cho ◽  
...  
Keyword(s):  
Emergency Department ◽  
South Korea ◽  
Medical Records ◽  
Clinical Characteristics ◽  
Systemic Infection ◽  
University Hospital ◽  
Altered Level ◽  
Level Of Consciousness ◽  
Before And After ◽  
Overall Mortality

Background: Altered level of consciousness (ALC) is a challenging condition in the emergency department (ED). We evaluated the clinical characteristics, causes, and prognosis of adult patients presenting with ALC at an ED of a university hospital.Methods: The medical records of patients with ALC who visited the ED of a university hospital from February 2019 to November 2020 were reviewed to compare before and after the outbreak of coronavirus disease-19 (COVID-19) in Daegu, South Korea. The cause of ALC, its classification, the patients’ destinations, and prognosis were carefully decided and compared.Results: A total of 1,851 patients with ALC in ED consisted of 1,068 before COVID-19 (BC; to February 17th, 2020) and 783 after COVID-19 (AC; from February 18th, 2020) were investigated. The all-time leading cause of ALC in ED was systemic infection (29.2% in BC, 25.0% in AC), followed by metabolic cause (21.0%) in BC and stroke (18.4%) in AC. Extra-cerebral etiologies of ALC were 1,206 (65.1%). The overall mortality of ALC in ED was 12.3%, consisting of 11.0% in BC and 14.2% in AC. During the daytime (07:00 to 18:59), patients in overall 1,179 patients (63.7%) with ALC visited ED, consisted of 665 (62.3%) in BC and 514 (65.5%) in AC.Conclusions: This study demonstrated the extra-cerebral etiologies as the major causes of ALC in the ED. And there have been shifts in the etiology of ALC in ED.

scholarly journals Childhood haemorrhagic stroke: a 7-year single-centre experience

2019 ◽  
Vol 104 (12) ◽  
pp. 1198-1202
Author(s):  
Lucia Gerstl ◽  
Katharina Badura ◽  
Florian Heinen ◽  
Raphael Weinberger ◽  
Aurelia Peraud ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Presentation ◽  
Vascular Malformations ◽  
Haemorrhagic Stroke ◽  
Child Therapy ◽  
University Hospital ◽  
Term Outcome ◽  
Altered Level ◽  
Level Of Consciousness ◽  
Arterial Ischaemic Stroke

BackgroundIn recent years, there has been increasing research interest in improving diagnostic and management protocols in childhood arterial ischaemic stroke (AIS). However, childhood stroke comprises, in approximately equal parts, both arterial ischaemic and haemorrhagic stroke (HS).ObjectiveThe aim of this study was to focus on the aetiology, clinical presentation, treatment and short-term outcome of children with spontaneous intracranial bleeding in a university hospital and elucidate differences to childhood AIS.DesignWe performed a retrospective analysis of electronic medical records of children (28 days–18 years) diagnosed with HS between 2010 and 2016.ResultsWe included 25 children (male child, n=11) with a median age of 8 years 1 month. The most common clinical presentations were vomiting (48%), headache (40%) and altered level of consciousness (32%). In more than half of the patients, HS was caused by vascular malformations. Other risk factors were brain tumour, coagulopathy and miscellaneous severe underlying diseases. Aetiology remained unclear in one child. Therapy was neurosurgical in most children (68%). Two patients died, 5 patients needed further (rehabilitation) treatment and 18 children could be discharged home.ConclusionsHS differs from AIS in aetiology (vascular malformations as number one risk factor), number of risk factors (‘mono-risk’ disease), clinical presentation (vomiting, headache and altered level of consciousness) and (emergency) therapy.

Direct ophthalmoscopy for the acute physicia – papilloedema and other abnormalities of the optic nerve head

2002 ◽  
Vol 1 (2) ◽  
pp. 60-63
Author(s):  
B Edmunds ◽  
◽  
P J Francis ◽  
Keyword(s):  
Optic Nerve ◽  
Optic Nerve Head ◽  
Visual Disturbance ◽  
Medical Setting ◽  
Altered Level ◽  
Level Of Consciousness ◽  
Systemic Disorder ◽  
Systemic Examination ◽  
Direct Ophthalmoscopy

Direct ophthalmoscopy is an essential part of the full systemic examination. However, the technique is challenging and time-consuming. In the acute medical setting therefore, it is advisable for the physician to identify the subgroup of patients in whom examination of the fundus is most likely to be helpful. Ophthalmoscopy should be performed where papilloedema is suspected, in those with an altered level of consciousness or other focal neurology, those with an unknown systemic disorder, and those complaining of visual disturbance.

scholarly journals Altered Mental Status and Cyanosis in a Pediatric Patient with Methemoglobinemia

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Phillip M. Grenz ◽  
Robert N. Ray Jr. ◽  
Olivia A. Hardy ◽  
Andrew L. Koons ◽  
Kenneth D. Katz ◽  
...  
Keyword(s):  
Mental Status ◽  
Clinical Manifestations ◽  
Altered Mental Status ◽  
Pediatric Emergency ◽  
Abrupt Onset ◽  
Altered Level ◽  
Sustained Improvement ◽  
Oxygen Dissociation ◽  
Nail Polish ◽  
Level Of Consciousness

Methemoglobinemia results from increased amounts of oxidized hemoglobin in the blood with an ensuing change in oxygen dissociation curve and lack of oxygen delivery to tissue. A previously well, male toddler was brought to the Pediatric Emergency Department (PED) by Emergency Medical Services (EMS) with abrupt onset of altered mental status and cyanosis after a suspected ingestion of “Rush” nail polish remover. He was quickly diagnosed with methemoglobinemia by both clinical presentation and chocolate-colored blood appearance. He emergently received intravenous (IV) methylene blue (MB) with immediate and sustained improvement requiring no further doses. Though inhalation of nitrites and subsequent methemoglobinemia is frequently reported in adolescents, we were unable to find any cases in the literature detailing ingestion of this product and the resulting clinical manifestations. Our objective with this report is to describe a rare case of a toddler with an accidental ingestion of “Rush” nail polish remover, a nitrite compound. Our patient presented to the PED with abrupt onset of altered level of consciousness, hypotension, and cyanosis resulting from acquired methemoglobinemia. This case report demonstrates the importance of emergency clinicians being able to make clinical judgements and decisions based on the history and physical exam when methemoglobinemia is suspected.

scholarly journals Brain Catastrophe presented with endocrine disruption

2020 ◽  
Vol 8 (5) ◽  
pp. 104-110
Author(s):  
Saadi JS AlJadir
Keyword(s):  
Dynamic Testing ◽  
Hemodynamic Instability ◽  
Major Surgery ◽  
Initial Manifestation ◽  
Altered Level ◽  
Identifiable Risk Factor ◽  
Conflicting Evidence ◽  
Level Of Consciousness ◽  
Threatening Condition ◽  
Life Threatening

Pituitary Apoplexy (PA) is an acute critical endocrine condition that is infrequently encountered in daily medical practice. Its life-threatening condition that mandates prompt diagnosis and urgent treatment and may be neurosurgical intervention. Majority of cases are attributed to ischemic infarction or hemorrhage of the pituitary gland usually in the vicinity of pituitary adenoma, and in most cases could be the initial manifestation of these tumors! In reviewing the literatures there is conflicting evidence of which are the predominant, non-functional, or functional adenomas, some reports were showed that prolactin-secreting are at highest risk. There are recognizable risk factors that might precipitate this endocrine emergency like hypertension, medications, major surgery, head injury, radiation, or dynamic testing, but in majority of cases at presentation no identifiable risk factor could be detected. The typical clinical scenario includes persistent worsening headache, vomiting, and altered level of consciousness, visual defect or loss with extreme hormonal derangements which are shown by hemodynamic instability, adrenal crises with variable hormonal deficiencies.

Intracerebral Hemorrhage

2015 ◽  
Author(s):  
Natalie P. Kreitzer ◽  
Opeolu Adeoye
Keyword(s):  
Intracerebral Hemorrhage ◽  
Vascular Malformations ◽  
Hemorrhagic Transformation ◽  
Amyloid Angiopathy ◽  
Reversal Agents ◽  
Computed Tomographic ◽  
Common Causes ◽  
Cerebral Amyloid ◽  
Criteria For Diagnosis ◽  
Neurologic Emergency

Intracerebral hemorrhage can be classified as either secondary (due to trauma, vascular malformations, aneurysms, tumors, or hemorrhagic transformation of ischemic stroke) or primary (without a clear secondary cause). Intracerebral hemorrhage is a neurologic emergency, and leads to significant death and disability each year; care should be expedited and emergency departments should be equipped to appropriately care for and manage these patients. This review covers the risk factors, natural history, pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes for patients with intracerebral hemorrhage. Figures show head computed tomographic scans demonstrating a left basal ganglia intracerebral hemorrhage, and an algorithm of management of intracerebral hemorrhage in the emergency department. Tables list some common causes of intracerebral hemorrhage, Boston criteria for diagnosis of cerebral amyloid angiopathy, mechanism of action of common anticoagulants, and suggested reversal agents. This review contains 2 highly rendered figures, 4 tables, and 79 references.

The Role of Long-Term Electroencephalogram Monitoring in the Prognostic Evaluation of Children with Disturbance of Consciousness in Pediatric Intensive Care Unit

2021 ◽  
Vol 7 (5) ◽  
pp. 1214-1221
Author(s):  
Xiaobo Wu ◽  
Ruiqin Qiu ◽  
Baoqi Li ◽  
Heyuan Gao ◽  
Ying Su
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Medical Records ◽  
Compliance Rate ◽  
Pediatric Intensive Care ◽  
Prognostic Evaluation ◽  
Disturbance Of Consciousness

This study aimed to investigate the role of long-term video electroencephalogram (VEEG) monitoring in the diagnosis and prognostic evaluation of children with disturbance of consciousness in pediatric intensive care unit (PICU). Materials and Methods : A retrospective analysis was performed on the medical records of 107 children with severe brain injury (SBI) who admitted to the PICU of The First Hospital of Qinhuangdao from January 2014 to December 2015. The medical records of 100 children with mild disturbance of consciousness were analyzed. All children underwent routine electroencephalogram (REEG) and VEEG detections. The diagnosis was completed by physicians according to the relevant operation instructions. The brain waveform of children was monitored. Result : The diagnostic results of REEG and VEEG were compared with clinical diagnostic results, and the relationship between the two detections and the prognosis of SBI children was analyzed. The sensitivity of VEEG in the diagnosis of SBI children was significantly higher than that of REEG (P<0.050). The specificity of VEEG in the diagnosis of SBI children was higher than that of REEG, with a statistical significance (P<0.050). The diagnostic compliance rate of VEEG in the diagnosis of SBI children was significantly higher than that of REEG (P<0.050). The sensitivity of VEEG in evaluating the prognosis of SBI children was significantly higher than that of REEG (P<0.050). The specificity of VEEG in evaluating the prognosis of SBI children was significantly higher than that of REEG. The coincidence rate of VEEG in evaluating the prognosis of SBI children was significantly higher than that of REEG (P<0.050). Conclusion: The results indicated that VEEG detection is effective in the diagnosis and prognostic evaluation of SBI children with disturbance of consciousness, which is worthy of promotion in clinical practice.

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