- Maayke Hunfeld, Netherlands
- Orsola Gawronski, Italy
Session Webcast
WHERE EVERYTHING IS AN OPTION
- Barney Scholefield, United Kingdom
- Barney Scholefield, United Kingdom
Presentation files
-
Where everything is an option in neurocritical care ESPNIC 2019 v2 18.06.2019 17:57
Video on Demand
IN A VERY LIMITED RESOURCE SETTING
- Hans-Joerg Lang, Switzerland
- Hans-Joerg Lang, Switzerland
Video on Demand
LOW RATES OF ADMINISTRATION OF PNEUMOCOCCAL VACCINATION IN OPEN HEAD TRAUMA DESPITE NATIONAL GUIDANCE
- Leanne Dearman, United Kingdom
- Leanne Dearman, United Kingdom
- Chris Kingsnorth, United States of America
- Salma Ali, United States of America
- Patrick Davies,
Abstract
Background
Invasive pneumococcal disease is a major cause of morbidity and mortality and is significantly more common in patients with open head trauma than the general population. Public Health England recommends that all such patients receive pneumococcal vaccination.
Objectives
Our aim was to assess whether patients presenting with open head trauma were immunised during their admission.
Methods
Analysis of digital health records, hospital reporting systems, and pharmacy dispensing for patients admitted to PICU between 01/01/2012–01/06/2018 identified 94 patients with major head trauma. 46 were excluded as their skull fracture was closed or notes were unavailable.
Results
48 patients had open head trauma. 15 (31%) received pneumococcal immunisation during their admission. 33 (69%) did not. 1 child presented 18 months post injury with devastating pneumococcal meningitis (albeit a strain not covered by the vaccination). Another received a prolonged course of antibiotics during her initial presentation for assumed meningitis (although all cultures were negative). Neither of these were immunised.
Conclusion
Our administration record was well below expected standards. We have contacted patients who did not receive pneumococcal vaccination and are arranging community administration. We are adding safeguards to ensure eligible patients are immunised at initial presentation. We plan to re-audit our performance 2 years after making these changes.
Video on Demand
PAEDIATRIC NEUROVASCULAR MALFORMATIONS IN INTENSIVE CARE: REPORT OF 44 CASES
- Joana M. Jones, Portugal
- Joana M. Jones, Portugal
- Cristina Camilo,
- Sofia Almeida,
- Leonor Boto,
- Francisco Abecasis,
- Marisa Vieira,
Abstract
Background
Ruptured vascular malformations are the most common cause of intracerebral haemorrhage in children, causing significant morbidity and mortality.
Objectives
To describe the therapeutic approach and neurological outcome in patients admitted to a paediatric intensive care unit (PICU) with arteriovenous malformations (AVMs) and cerebral aneurysms (CAs).
Methods
Retrospective chart review of patients admitted to PICU with AVMs and CAs between January 2008 and December 2018. Neurologic outcome was assessed using King’s Outcome Scale for Childhood Head Injury (KOSCHI), considering good recovery KOSCHI 4-5; vegetative/ severe disability KOSCHI 2-3.
Results
28 cases of AVMs (64%) and 16 CAs (36%) were included: mean age 8.9 years (+/-5.1). Brain CT scan showed subarachnoid hemorrhage in 63% of CAs and parenchymatous haemorrhage in 64% of AVMs. All patients had neurocritical care, fifty-percent of patients underwent neurosurgery and 23% neuroradiological intervention. Seizures were more common in the AVM group (29 vs 6%), unlike vasospasm (11 vs 25%). Rebleeding rate was similar between groups (18 vs 19%), but occurred earlier and with higher mortality in CAs (2/3 within 48h of admission, both died) than AVMs (5/5 after the first week, one died). Another patient died, from ruptured CA (brain death on admission). On transfer from PICU, incidence of neurologic sequelae was similar (57% in AVMs vs 50% in CAs group). At present time: 75% of AVMs vs 69% of ACs show good recovery; 39% of AVMs vs 6,25% of CAs have severe disability.
Conclusion
Early rebleeding had a dismal outcome in our series, justifying a prompt intervention in cases of CAs.
Presentation files
-
ESPNIC joanajones.rev2MV 20.06.2019 01:14
-
ESPNIC joanajones.revMV 20.06.2019 00:49
Video on Demand
RISK EVALUATION OF MALIGNANT INTRACRANIAL HYPERTENSION DEVELOPMENT IN CHILDREN WITH SEVERE TRAUMATIC BRAIN INJURY
- Mariia Akhlebinina, Russian Federation
- Ilia Melnikov, Russian Federation
- Tolibdzhon Akhadov, United States of America
- Mariia Akhlebinina, Russian Federation
- Maxim Ublinskiy, Russian Federation
Abstract
Background
Brain swelling is one of the most dangerous complications of primary traumatic brain injury (TBI), which leads to rise of intracranial pressure (ICP). We propose that DWI can be a useful tool for evaluating the risk of malignant intracranial hypertension development and can be used to determine the need of decompressive craniectomy in patients with severe TBI.
Objectives
To determine the potential of DWI in assessing the risk of developing malignant intracranial hypertension in children with severe TBI.
Methods
We retrospectively evaluated clinical and MRI data of 36 pediatric patients with severe TBI. The severity of clinical condition of each patient was evaluated with the use of the Glasgow Coma Scale (GCS). Parenchymal ICP gauge placement was performed in all patients for adequate ICP monitoring. Patients were categorized into three groups: (1) high ICP managed conservatively; (2) malignant ICP managed with DC; (3) normal ICP. Four pairs of symmetrical ROIs were manually drawn on ADC maps. All ROIs excluded areas that appeared abnormal on T2WI.
Results
Average ADC values in the deep white matter of frontal lobes were significantly increased in children with severe TBI with following DC (851.5+/-54.3x10-3 mm2/sec) compared to those with severe TBI and conservatively controlled ICP (756.4+/-40.5x10-3 mm2/sec; p<0.05).
Conclusion
Assessment of DWI values in severe pediatric TBI is a potential tool for evaluating the risk of malignant ICP development. Early identification of children at high risk for this complication may assist in earlier aggressive clinical management of pediatric TBI patients.
Video on Demand
NEUROTRANSMISSION DISTURBANCES AFTER MILD PEDIATRIC TBI
- Natalia Semenova, United States of America
- Petr Menshchikov, Russian Federation
- Andrei Manzhurtsev, Russian Federation
- Maxim Ublinskiy, Russian Federation
- Tolibdzhon Akhadov, United States of America
- Natalia Semenova, United States of America
Abstract
Background
The vast majority of mild traumatic brain injury (mTBI) cases do not lead to abnormalities of brain structures. The correlation between early structural neuroimaging findings and long-term clinical outcomes is weak.
Objectives
The main aim of this work was to estimate changes in in vivo cerebral GABA and Glutamate concentrations after acute mTBI using 1H MRS.
Methods
Two groups of participants were included in the study: patients (n=11, mean age–16±2 years) with acute mTBI (mean time between trauma and MRI examination 40±20 hours); 8 healthy children (mean age-16±1 years) without history of any TBIs. MR acquisition: 1H MR spectra were acquired on scanner 3 T MRI scaner using PRESS (NAA, Creatine, Choline signals) and MEGA PRESS (GABA and Glutamate signals) pulse sequences. All voxels in size of 25×25×30 mm were located in the frontal lobe
Results
The main effect on the [GABA] was found (Z=2.03, p<0.05), with the patients having higher [GABA] as compared to the control group (36%). Absolute concentrations of NAA+NAAG, tCho, tCr and glutamate were unchanged.
Conclusion
This study for the first time revealed increased cerebral [GABA] as well as disorders in the [GABA]/[GLX] balance in the pediatric acute mTBI. The most likely cause of [GABA] increase is growth of free pool of GABA (non-related to GABA receptors). Postconcussion changes of neurotransmitter revealed in the present study could be promising for understanding of functional consequences of MRI negative TBI.