Transcranial Doppler in a child: A most valuable imaging modality

Introduction Pediatric brain injury is a common cause of emergency department (ED) referral. Although severe traumatic brain damage is less frequent, it could be primarily managed by non-pediatric critical care physicians called in for advice. Clinical evaluation is important, but radiology is of particular value in the case of severe brain injury. Transcranial Doppler may help the physician through neuromonitoring. Case Report We report the case of a 3-year-old male child brought into the pediatric ED for a moderate head injury. His neurological status deteriorated rapidly, making endotracheal intubation and mechanical ventilation necessary. Computed tomography (CT) of the head revealed brain contusion and post-traumatic subarachnoidal hemorrhage. Discussion Transcranial Doppler was performed at the standard transtemporal evaluation window, and it showed normal vascularization of the entire anterior brain. This result permitted performance of the control CT scan to be postponed. In this case, basic knowledge of transcranial ultrasound proved to be useful, and we believe it could also be useful to other colleagues faced with similar situations even if they are not dedicated to pediatric critically ill patients. Conclusion Doppler ultrasound in the pediatric population is a valuable bedside tool. Together with clinical evaluation and radiology, it completes the set of techniques necessary for continuous neuromonitoring.

Status epilepticus in the Paediatric Intensive Care Unit

This chapter covers pertinent issues around the management of children with status epilepticus within and outside of specialist centres. A detailed overview of the work-up of a child in status epilepticus is presented. Additionally, the potential management of patients with refractory status epilepticus and super-refractory status epilepticus is evaluated. Furthermore, the chapter focuses on strategies to aid decision-making related to the practical challenges paediatric intensivists face, such as the suitability of extubating patients at the referring hospital, the decision to transfer patients to specialist centres for ongoing management, the role of neuroimaging, and about use of quantitative electroencephalogram (EEG) as a continuous neuromonitoring modality.

Acute Spinal Cord Contusion in a Patient with Multiple Upper Cervical Fractures, Parkinson’s Disease, and Torticollis: Surgical Management

Case Report. Spine surgery in patients with Parkinson’s disease (PD) involves increased risk. We describe a case of cervical myelopathy in a patient with PD, multiple fractures involving the atlas and axis vertebrae, and spasmodic torticollis. The patient was successfully treated with an upper cervical decompression and occipital-cervical (OC) fusion surgery. Strategies for torticollis reduction and successful surgical outcome are discussed. Risks and benefits must be carefully weighed when considering occipital cervical fusion in PD patients. Conclusion. Intraoperative manual reduction of laterocollis is possible after general endotracheal anesthesia, and continuous neuromonitoring is established. Use of optimizing strategies such as perioperative botulinum injections and intraoperative O-arm navigation should be considered.

New Techniques in Thyroid Surgery – Critical Evaluation

Introduction: Operations due to benign and malignant thyroid neoplasms constitute a significant percentage of operations in general and oncological surgery wards. Therefore, unsurprisingly, better and better methods are being sought to avoid the occurrence of two major complications after those operations, i.e. laryngeal nerve palsy and hypoparathyroidism and new minimally invasive accesses. M aterial and methods: Authors searched MEDLINE database using the following search terms: modern technologies AND/ OR thyroid surgery AND/OR intermittent neuromonitoring AND/OR continuous neuromonitoring AND/OR parathyroid preservation AND/OR transoral endoscopic thyroidectomy AND/OR TOETVA. Results: The paper discusses the following new techniques of thyroid surgery with particular focus on limitations: neuromonitoring, narrowband imaging, fluorescence angiography and transoral endoscopic thyroidectomy by vestibular approach. Conclusions: Some of the new techniques are highly clinically useful. Their use can become a routine element of standard thyroidectomy.