Pediatric Stroke: A Review

ABSTRACT Background and objectives: Pediatric Stroke is a neurological disorder in which the patient suffers with two or more Pediatric stroke is a focal neurological deficit lasting more than 24 hours because of stenosis, occlusion or rupture of cerebral blood vessels. Variable etiological factors are involved ranging from cardiac, haematological, infectious, immune mediated to arteriopathies which is emerging as most important cause of arterial ischemic stroke in children. In this review article we will discuss paediatric stroke with its epidemiology, etiological factors in particular arteriopathies, diagnostic modalities, management protocols and outcome. Methods: We searched stroke in Pubmed and found 15315 articles, narrowed down to stroke in children (3814) and selected 45 articles for review. Review: Stroke in children is defined as a focal neurological deficit that persists for more than 24 hours and is caused by stenosis, occlusion or rupture of cerebral blood vessels. Stroke may be arterial, venous or because of occlusion of venous sinuses. Arterial strokes may be ischemic, haemorrhagic or ischemic-haemorrhagic. About half of strokes in children are of arterial ischemic strokes in contrast to adults where about 80-85% strokes are of arterial ischemic strokes. Stroke in children is comparable to brain tumors and is one of top ten common causes of death in children. Arterial ischemic stroke in children has significant risk of mortality and morbidity leading to functional disability of patient along with financial burden over family and society. In one study it was estimated that 10-25% of children with stroke die, 25% have recurrence and about 66% of children have neurological deficit after recovery from acute illness or have future epilepsy, behaviour disorder or learning disabilities. Early recognition and prompt treatment of paediatric stroke can reduce mortality, morbidity and in return can reduce both social and financial burden over society. Conclusion: In this review article we will discuss paediatric strokes, epidemiology, risk factors, differential diagnosis, investigations, management protocols, preventive measures and outcome

Central nervous system tuberculosis in children

Brain and spinal cord tuberculosis are one of the commonest neurological infection in developing countries. Its associated with high morbidity and mortality. Diagnosis is based on clinical features, cerebrospinal fluid and brain imaging. Combination of antituberculous drugs should be started as early as possible to prevent the complications. The patient\u27s clinical stage at presentation is the most important prognostic factor. Surgical procedures are directed at management of the hydrocephalus. Focal lesions, intracranial tuberculomas, and tuberculous abscesses, are usually located in cerebral or cerebellar hemispheres, uncommonly in brainstem and very rarely in spinal cord. They do not usually require surgical intervention and respond well to antituberculous treatment, along with corticosteroids. All these fsctors pertaining to tuberculosis of brain and spine will be adressed in this review article

Behavioral challenges in Childhood Epilepsy

Behavioral problems among children with epilepsy is one of the most common problem. Severity of the problem ranges from 16% to 77% as compared to 9% in the general pediatric population. Such a huge variation in the results reflects probable difference in the methodology. Structured interviews that include parents, children and clinician’s reports have identified a higher rate of behavioral problems when compared to self-report instruments. Higher rates are reported in clinical samples recruited from tertiary care medical centers, where they have a lot of referrals from the peripheral small units. Most researchers agree that children with epilepsy have three to nine times higher risk of behavioral problems as compared to healthy controls and children with non neurological disorders. We searched pub med with key words epilepsy in children (41061), psychological problems in children (13523) and psychological problems in children with epilepsy (240). Out of these 240 articles, 35 were selected for reviewed. This review article reflects that if we look into our local experience, perhaps we are also facing the same kind of spectrum in terms of behavioral problems in children with epilepsy

The Moral Obligation to Prioritize Research Into Deep Brain Stimulation Over Brain Lesioning Procedures for Severe Enduring Anorexia Nervosa

Deep Brain Stimulation is currently being investigated as an experimental treatment for patients suffering from treatment-refractory AN, with an increasing number of case reports and small-scale trials published. Although still at an exploratory and experimental stage, initial results have been promising. Despite the risks associated with an invasive neurosurgical procedure and the long-term implantation of a foreign body, DBS has a number of advantageous features for patients with SE-AN. Stimulation can be fine-tuned to the specific needs of the particular patient, is relatively reversible, and the technique also allows for the crucial issue of investigating and comparing the effects of different neural targets. However, at a time when DBS is emerging as a promising investigational treatment modality for AN, lesioning procedures in psychiatry are having a renaissance. Of concern it has been argued that the two kinds of interventions should instead be understood as rivaling, yet “mutually enriching paradigms” despite the fact that lesioning the brain is irreversible and there is no evidence base for an effective target in AN. We argue that lesioning procedures in AN are unethical at this stage of knowledge and seriously problematic for this patient group, for whom self-control is particularly central to wellbeing. They pose a greater risk of major harms that cannot justify ethical equipoise, despite the apparent superiority in reduced short term surgical harms and lower cost

Ongoing WTO Negotiations and Bangladesh’s Interests: Insights from CPD’s October 2002 Tracking Mission to Geneva

The paper is based on the participation of CPD delegation in Geneva and gives an insight into the particular issue of priority interest to Bangladesh in the context of the ongoing negotiations including GATS, AoA, TRIPS and Market Access.The paper provides an understanding about the important implications of the ongoing Doha Development Round negotiations for Bangladesh and other least developed countries (LDCs) both in terms of accessing the opportunities emanating from the evolving global trading system, and also from the perspective of addressing the attendant challenges.WTO-General Council, Tracking Mission, Geneva, Bangladesh

Frequency of cerebrovascular accidents and brain abscess in childrens with tetralogy of fallot Dr.

OBJECTIVE: To determine the frequency of cerebrovascular accidents and brain abscess in children of Tetralogy of Fallot presented with neurological manifestations. PATIENTS AND METHODS: It was a cross-sectional descriptive observational study done at the Pediatric Cardiology and Pediatric Neurology departments of The Children’s Hospital & Institute of Child Health, Lahore from Dec 2009 to Nov 2010. A total 75 patients of Tetralogy of Fallot (TOF) up to the age of 15 years with neurological manifestation meeting the inclusion criteria were enrolled in this study. CT brain with contrast was conducted in all patients to look for evidence of cerebrovascular accident (stroke) and/or brain abscess. RESULTS: Out of total 75 patients of Tetralogy of Fallot (TOF) presented with neurological manifestation 48 (64%) were having brain abscess, 24 (32%) were having cerebrovascular accident (CVA), 2 (2.6%) were having intracranial bleed and 1 (1.3%) was having meningoencephlitis. Disease breakdown according to age showed increasing frequency of brain abscess as age increases with maximum cases above 10 years of age. However maximum cases of CVA reported in patients below age of 2years. CONCLUSION: Brain abscess have found to be more frequent than cerebrovascular accidents in patients with tetralogy of fallot. Therefore, we should have a high index of suspicion of brain abscess in every unoperated patient of tetralogy of fallot presenting with neurological manifestation

Abstracts 4th pediatric neurology conference children medical center, lahore february 2013

Clinical data of 100 patients being treated as TBM (group A) admitted in the Neurology department, and another 100 patients with diagnosis of meningitis, encephalitis or cerebral malaria (group B) were evaluated. History, clinical examination and relevant investigations were evaluated and Kenneth Jones criteria were applied to both groups. All children were followed and their outcome was also studied

Deep Brain Stimulation (DBS) Applications

The issue is dedicated to applications of Deep Brain Stimulation and, in this issue, we would like to highlight the new developments that are taking place in the field. These include the application of new technology to existing indications, as well as ‘new’ indications. We would also like to highlight the most recent clinical evidence from international multicentre trials. The issue will include articles relating to movement disorders, pain, psychiatric indications, as well as emerging indications that are not yet accompanied by clinical evidence. We look forward to your expert contribution to this exciting issue