3 results
5 - Advanced neuroimaging techniques in children with traumatic brain injury
- Edited by Vicki Anderson, University of Melbourne, Keith Owen Yeates, Ohio State University
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- Book:
- Pediatric Traumatic Brain Injury
- Published online:
- 14 May 2010
- Print publication:
- 04 February 2010, pp 68-93
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Summary
Pediatric traumatic brain injury remains a major public health problem. Fortunately, the advent of several neuroimaging techniques has improved our ability to better diagnose and treat affected children. Because intensive care therapy has resulted in lowered mortality and morbidity, attention is also focusing on issues related to brain recovery and reorganization. It is likely that, in the future, imaging may better define the relation between structural and functional deficits and approaches will be developed to guide treatment paradigms. In this review, we examine four imaging methods that are increasingly used for the assessment of pediatric brain injury. Susceptibility weighted imaging is a 3-D high-resolution magnetic resonance imaging technique that is more sensitive than conventional imaging in detecting hemorrhagic lesions that are often associated with diffuse axonal injury. Magnetic resonance spectroscopy acquires metabolite information reflecting neuronal integrity and functions from multiple brain regions and provides sensitive, non-invasive assessment of neurochemical alterations that offers early prognostic information regarding outcome. Diffusion weighted imaging is based on differences in diffusion of water molecules within the brain and is sensitive in the early detection of ischemic injury. Diffusion tensor imaging is a form of diffusion weighted imaging and allows better evaluation of white matter fiber tracts by taking advantage of the intrinsic directionality (anisotropy) of water diffusion in human brain and is useful in identifying white matter abnormalities after diffuse axonal injury.
18 - Brain Death, Minimal Consciousness, and Vegetative States in Children
- Edited by Geoffrey Miller , Yale University, Connecticut
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- Book:
- Pediatric Bioethics
- Published online:
- 07 May 2010
- Print publication:
- 23 November 2009, pp 247-261
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Summary
This chapter outlines the two means of determining biological death: one is cardiopulmonary, and the other neurological. It provides support for the continued use of the brain death concept based on operational usefulness and its moral rightness in that it can provide good in the absence of harm and, for most, in the absence of offense to intuition or moral sense. Brain death is the irreversible cessation of whole-brain function, which would be followed by the cessation of cardiopulmonary function without the institution of artificial measures. Recognition of the vegetative state (VS) entails a clinical diagnosis. The VS is likely to be permanent 12 months after traumatic brain injury and 3 months after nontraumatic injury in children. Minimally conscious state (MCS) is considered by some to be a neurological state whose recognition allows special legal and moral consideration. The interpretation of "minimal" becomes "hardly different from vegetative".
5.1 - Long-term ventilation in a child with severe central nervous system impairment
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- By Ronald M. Perkin, M.D. Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, North Carolina 27834, USA, Robert Orr, M.D., C.M., Director of Clinical Ethics University of Vermont College of Medicine, Burlington, Vermont 05405, USA, Stephen Ashwal, M.D. Department of Pediatrics, Division of Child Neurology, Loma Linda University Adventist Health Sciences Center, Loma Linda, California 92350, USA
- Edited by Lorry R. Frankel, Stanford University, California, Amnon Goldworth, Stanford University, California, Mary V. Rorty, Stanford University, California, William A. Silverman, Columbia University, New York
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- Book:
- Ethical Dilemmas in Pediatrics
- Published online:
- 18 August 2009
- Print publication:
- 10 June 2005, pp 113-118
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Summary
The case
The following question was brought for ethics consultation. Is it appropriate to initiate long-term ventilation for a child with severe neurologic compromise in order to avoid repeated respiratory exacerbations which necessitate transfer from his long-term care facility to a tertiary intensive care unit?
This case involved a 26-month-old male who was healthy at birth but developed a severe case of bronchiolitis caused by respiratory syncytial virus at two months of age. This illness resulted in apnea which was followed by cardiac arrest. Although he was successfully resuscitated, he did not recover neurologically and at the time of writing, approximately three years after his cardiac arrest, he was in a persistent vegetative state that was judged to be permanent.
The child was transferred to a chronic care facility at five months of age (three months after his cardiorespiratory arrest). He had a tracheostomy as well as a fundoplication and gastrostomy tube performed prior to his long-term placement. Once established in the long-term care facility the child required 23 transfers and admissions to a tertiary care facility over a 20-month period for episodes of hypercapnic respiratory failure. The child's respiratory drive was not consistently maintained and each time his respiratory drive failed he required admission to the pediatric intensive care unit (PICU) and mechanical ventilation for 7–10 days. Consideration of long-term ventilation at the chronic care facility was suggested to avoid these repeated transfers and to decrease his overall costs of care.