Neonatal neurocritical care considerations for prenatally identified neurological disorders

With increased access to advanced prenatal neuroimaging and genetic testing, neurological disorders such as brain malformations, brain injuries, and genetic disorders, are increasingly being diagnosed during pregnancy. In this review, we address neonatal neurocritical care considerations for the population with prenatally identified neurological disorders. We identify antenatal considerations, including planning location of delivery, as well as postnatal considerations, including clinical phenotyping, neuromonitoring, neuroimaging, and genetic testing. The importance of interdisciplinary collaboration between obstetrics, maternal-fetal medicine, neonatology, pediatric neurology, neuroradiology, genetics, palliative care, early intervention and habilitative services is emphasized. We outline high-priority research gaps, and highlight the need for large, multicenter studies that capture diverse geographies, populations, care practices and settings longitudinally. IMPACT: Fetal neurology is a rapidly evolving field owing to the increased prenatal diagnosis of neurological disorders; however, the natural history of many fetal neurological disorders is not well known. We identify interdisciplinary neonatal neurocritical care considerations for newborns with prenatally diagnosed neurological disorders, such as neuroimaging, neuromonitoring, and family support. We outline high-priority research gaps in fetal neurology relevant to neurocritical care, including the need to prioritize large-scale longitudinal studies on the etiologies, short- and long-term outcomes of fetal neurologic disorders across diverse geographies and populations to improve counseling and care

ACR-ACNM-ASNR-SNMMI Practice Parameter for the Performance of Brain PET/CT Imaging in Dementia

AIM/OBJECTIVES/BACKGROUND: This practice parameter was revised collaboratively by the American College of Radiology (ACR), the American College of Nuclear Medicine (ACNM), the American Society for Neuroradiology (ASNR), and the Society of Nuclear Medicine and Molecular Imaging (SNMMI).This important update now includes all FDA approved agents for PET imaging of dementia and reflects the expanding role of PET imaging for the early and more accurate diagnostic characterization of the neurodegenerative processes underlying cognitive deterioration. Clinical indications, personnel qualifications, and technical specifications are discussed in this practice parameter. METHODS: This practice parameter was revised according to the process described under the heading The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website (https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards) by the Committee on Practice Parameters - Neuroradiology of the ACR Commission on Neuroradiology and the Committee on Practice Parameters - Nuclear Medicine and Molecular Imaging of the ACR Commission on Nuclear Medicine and Molecular Imaging in collaboration with the ACNM, the ASNR, and the SNMMI. RESULTS: ACR/ACNM/ASNR/SNMMI collaborative work to update the practice parameter of Brain PET imaging. The new parameter includes all FDA approved PET agents for the evaluation of dementia. CONCLUSIONS: The updated practice parameter is intended to serve as a reference for clinical indications, technical specifications, and personnel qualifications state for PET/CT imaging in dementia

Tailoring transdermal estradiol dose to maximize benefits and minimize risks

Transdermal estradiol is licensed to treat estradiol deficiency symptoms and prevent osteoporosis in postmenopausal women. There is no one-size-fits-all estradiol dose or serum concentration that will achieve symptom relief and bone protection in all women. Dose is usually titrated to symptom response, but measurement of serum estradiol concentration can be used to support or inform dose decisions in certain clinical scenarios. The optimal level for an individual varies according to tissue sensitivity (pharmacodynamic effects), the method used for estradiol quantitation (immunoassay vs. mass spectrometry), the clinical endpoint (symptoms vs. bone protection), and treatment goals, including patient preferences. An understanding of transdermal estradiol pharmacokinetics and pharmacodynamics, and the limitations of the methods used to measure serum estradiol, is essential to ensure that all women who choose to use menopausal hormone therapy (MHT) can reap the benefits and avoid the harms of over-treatment and under-treatment. Achieving and maintaining optimal estradiol levels for all MHT users is consistent with menopause guidelines that promote high-quality, patient-centred, personalized menopause care

Delayed Emergence From Anesthesia After Esophagogastroduodenoscopy/Colonoscopy in an Adult Patient With Narcolepsy

Endoscopic procedures such as esophagogastroduodenoscopy and colonoscopy are commonly performed under propofol-based anesthesia due to its rapid onset and recovery. However, delayed emergence is a rare but clinically significant concern, especially in patients with neurological disorders such as narcolepsy. We report a 28-year-old woman (body mass index: 35.8) who exhibited delayed emergence approximately 10 hours after esophagogastroduodenoscopy and colonoscopy for evaluation of iron deficiency anemia. She received lidocaine 80 mg IV, followed by propofol 900 mg IV over 45 minutes. Postprocedure, she remained sedated despite unremarkable laboratory and neurologic imaging, including head computed tomography angiogram and perfusion studies. She was monitored in the ICU and gradually regained consciousness without intervention. Before discharge, she disclosed a history of narcolepsy, unrecognized preoperatively. This case underscores the importance of thorough preoperative screening for sleep disorders, as narcolepsy can alter anesthetic sensitivity and prolong sedation, necessitating close collaboration between gastroenterologists and anesthesiologists