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Neurogical Complications: Intracranial Bleeding, Stroke and Seizures

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Critical Care of Children with Heart Disease

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Abstract

Within the first 12 months of life, approximately one-third to one-half of the 30,000–40,000 infants born in the United States each year with congenital heart disease (CHD) will undergo cardiac surgery [1, 2]. This large infant group is an accessible population for detailed assessment of medical and surgical techniques as well as outcome measurements. Over 50 years ago, before the advent of cardiopulmonary bypass, which allowed for open heart surgery, survival was the goal not often realized for these patients. Each decade has heralded surgical and medical advances that have decreased mortality. Intraoperative strategies now favor low-flow bypass over deep hypothermic circulatory arrest, and acid–base management prefers the acidotic pH-stat approach to the alkalotic alpha-stat strategy. In recent years, there has been a shift in emphasis to neurological morbidity. As neurological outcomes have become more important, cardiac intensive care unit (CICU) care is increasingly including the neurologist to help detect, manage, and offer prognosis for neurological complications. A full appreciation of the unique vulnerability of the cerebral vasculature and brain anatomy, along with understanding the major neurological complications of CHD, will guide comprehensive care for this special pediatric population.

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References

  1. Hahn CD, du Plessis AJ. Neurological Disorders Associated with Cardiac Disease. In: Swaiman KF, Ashwal S, Ferriero DM, eds. Pediatric Neurology: Principles and Practice. 4th ed. Philadelphia: Mosby; 2006:2207-2231.

    Google Scholar 

  2. Licht DJ, Wang J, Silvestre DW, et al. Preoperative cerebral blood flow is diminished in neonates with severe congenital heart defects. J Thorac Cardiovasc Surg. 2004;128:841-849.

    PubMed  Google Scholar 

  3. van Houten JP, Rothman A, Bejar R. High incidence of cranial ultrasound abnormalities in full-term infants with congenital heart disease. Am J Perinatol. 1996;13:47-53.

    Article  PubMed  Google Scholar 

  4. Glauser TA, Rorke LB, Weinberg PM, et al. Congenital brain anomalies associated with the hypoplastic left heart syndrome. Pediatrics. 1990;85:984-990.

    PubMed  CAS  Google Scholar 

  5. Volpe JJ. Neurology of the newborn. Philadelphia: WB Saunders; 2001:428-493.

    Google Scholar 

  6. van Houten J, Rothman A, Bejar R. Echoencephalographic (ECHO) findings in infants with congenital heart disease. Pediatrics Res. 1993;33:376A.

    Google Scholar 

  7. Mahle WT, Tavani F, Zimmerman RA, et al. An MRI study of neurological injury before and after congenital heart surgery. Circulation. 2002;106:I109-I114.

    PubMed  Google Scholar 

  8. Glauser TA, Rorke LB, Weinberg PM, et al. Acquired neuropathologic lesions associated with the hypoplastic left heart syndrome. Pediatrics. 1990;85:991-1000.

    PubMed  CAS  Google Scholar 

  9. Young RSK, Liberthson RR, Zalneraitis EL. Cerebral hemorrhage in neonates with coarctation of the aorta. Stroke. 1982;13:491-494.

    Article  PubMed  CAS  Google Scholar 

  10. Tavani F, Zimmerman RA, Clancy RR, et al. Incidental intracranial hemorrhage after uncomplicated birth: MRI before and after neonatal heart surgery. Neuroradiology. 2003;45:253-258.

    PubMed  CAS  Google Scholar 

  11. du Plessis AJ. Neurologic disorders. In: Chang AC, Hanley FL, Wernovsky G, Wessel DL, eds. Pediatric Cardiac Intensive Care. Baltimore: Williams and Wilkins; 1998:369-386.

    Google Scholar 

  12. McClure CD, Johnston JK, Fitts JA, et al. Postmortem intracranial neuropathology in children following cardiac transplantation. Pediatr Neurol. 2006;35:107-113.

    Article  PubMed  Google Scholar 

  13. Schoenberg B, Mellinger J, Schoenberg D. Cerebrovascular disease in infants and children: a study of incidence, clinical features, and survival. Neurology. 1978;28:763-768.

    Article  PubMed  CAS  Google Scholar 

  14. Giroud M, Lemesle M, Gouyoun JB, et al. Cerebrovascular disease in children under 16 years of ago in the city of Dijon, France: a study of incidence and clinical features from 1985 to 1993. J Clin Epidemiol. 1995;48:1343-1348.

    Article  PubMed  CAS  Google Scholar 

  15. Lanska MJ, Lanska DJ, Horwitz SJ, et al. Presentation, clinical course, and outcome of childhood stroke. Pediatr Neurol. 1991;7:333-341.

    Article  PubMed  CAS  Google Scholar 

  16. Riela AR, Roach ES. Etiology of stroke in children. J Child Neurol. 1993;8:201-220.

    Article  PubMed  CAS  Google Scholar 

  17. Galli KK, Zimmerman RA, Jarvik GP, et al. Periventricular leukomalacia is common after neonatal cardiac surgery. J Thorac Cardiovasc Surg. 2004;127:692-704.

    Article  PubMed  Google Scholar 

  18. du Plessis A, Chang A, Wessel D, et al. Cerebrovascular accidents following the Fontan procedure. Pediatr Neurol. 1995;12:230-236.

    Article  PubMed  Google Scholar 

  19. Day R, Boyer R, Tait V, et al. Factors associated with stroke following the Fontan procedure. Pediatr Cardiol. 1995;16:270-275.

    Article  PubMed  CAS  Google Scholar 

  20. Rosenthal DN, Friedman AH, Kleinman CS, et al. Thromboembolic complications after Fontan operations. Circulation. 1995;92:II287-II293.

    Article  PubMed  CAS  Google Scholar 

  21. Lutas EM, Roberts RB, Devereux RB, et al. Relation between the presence of echocardiographic vegetations and the complication rate in infective endocarditis. Am Heart J. 1986;112:107-113.

    Article  PubMed  CAS  Google Scholar 

  22. Pelletier LL, Petersdorf RG. Infective endocarditis: a review of 125 cases from the University of Washington Hospitals, 1963–72. Medicine. 1977;56:287-313.

    Article  PubMed  Google Scholar 

  23. Roy P, Tajik AJ, Giuliani ER, et al. Spectrum of echocardiographic findings in bacterial endocarditis. Circulation. 1976;53:474-482.

    Article  PubMed  CAS  Google Scholar 

  24. Pruitt AA, Rubin RH, Karchmer AW, et al. Neurological complications of bacterial endocarditis. Medicine. 1978;57:329-343.

    Article  PubMed  CAS  Google Scholar 

  25. Cromme-Dijkhuis AH, Henkens CM, Bijleved CM, et al. Coagulation factor abnormalities as possible thrombotic risk factors after Fontan operations. Lancet. 1990;336:1087-1090.

    Article  PubMed  CAS  Google Scholar 

  26. Linderkamp O, Klose JK, Betke K, et al. Increased blood viscosity in patients with cyanotic congenital heart disease and iron deficiency. J Pediatr. 1979;95:567-569.

    Article  PubMed  CAS  Google Scholar 

  27. Komp DM, Sparrow AW. Polycythemia in cyanotic heart disease–a study of altered coagulation. J Pediatr. 1970;76:231-236.

    Article  PubMed  CAS  Google Scholar 

  28. Lutterman J, Scott M, Nass R, et al. Moyamoya syndrome associated with congenital heart disease. Pediatrics. 1998;101:57-60.

    Article  PubMed  CAS  Google Scholar 

  29. Petäjä J, Lundström U, Sairanen H, et al. Central venous thrombosis after cardiac operations in children. J Thorac Cardiovasc Surg. 1996;112:883-889.

    Article  PubMed  Google Scholar 

  30. Schievink WI, Mokri B, Peipgras DG, et al. Intracranial aneurysms and cervicocephalic arterial dissections associated with congenital heart disease. Neurosurgery. 1996;39:685-689.

    Article  PubMed  CAS  Google Scholar 

  31. Yang JS, Park YD, Hartlage PL. Seizures associated with stroke in childhood. Pediatr Neurol. 1995;12:136-138.

    Article  PubMed  CAS  Google Scholar 

  32. Clancy R, Malin S, Laraque D, et al. Focal motor seizures heralding stroke in full-term neonates. Am J Dis Child. 1985;139:601-606.

    PubMed  CAS  Google Scholar 

  33. Grossman RI, Yousem DM. Neuroradiology: The Requisites. Philadelphia: Mosby; 2003.

    Google Scholar 

  34. Barber PA, Darby DG, Desmond PM, et al. Identification of major ischemic change. Diffusion-weighted imaging versus computed tomography. Stroke. 1999;30:2059-2065.

    Article  PubMed  CAS  Google Scholar 

  35. Janjua N, Nasar A, Lynch JK, et al. Thrombolysis for ischemic stroke in children: data from the nationwide inpatient sample. Stroke. 2007;38:1850-1854.

    Article  PubMed  Google Scholar 

  36. Okada Y, Yamaguchi T, Minematsu K, et al. Hemorrhagic transformation in cerebral embolism. Stroke. 1989;20:598-603.

    Article  PubMed  CAS  Google Scholar 

  37. Sherman DG, Dyken ML, Fisher M, et al. Antithrombotic therapy for cerebrovascular disorders. Chest. 1992;102:529S-537S.

    Article  PubMed  CAS  Google Scholar 

  38. Yatsu RM, Hart RG, Mohr JP, et al. Anticoagulation of embolic strokes of cardiac origin: an update. Neurology. 1988;38:314-316.

    Article  PubMed  CAS  Google Scholar 

  39. Eriksson M, Zetterstrom R. Neonatal convulsions. Incidence and causes in the Stockholm area. Acta Paediatra Scand. 1979;68:807-811.

    Article  CAS  Google Scholar 

  40. Bergman I, Painter MJ, Hirsch RP, et al. Outcomes in neonates with convulsions treated in an intensive care unit. Ann Neurol. 1983;14:642-647.

    Article  PubMed  CAS  Google Scholar 

  41. Lanska MJ, Lanska DJ, Baumann RJ, et al. A population-based study of neonatal seizures in Fayette County, Kentucky. Neurology. 1995;45:724-732.

    Article  PubMed  CAS  Google Scholar 

  42. Clancy RR, Sharif U, Ichord R, et al. Electrographic neo­natal seizures after infant heart surgery. Epilepsia. 2005;46:84-90.

    Article  PubMed  Google Scholar 

  43. Menache CC, du Plessis AJ, Wessel DL, et al. Current incidence of acute neurologic complications after open-heart operations in children. Ann Thorac Surg. 2002;73:1752-1758.

    Article  PubMed  Google Scholar 

  44. Gaynor JW, Nicolson SC, Jarvik GP, et al. Increasing duration of deep hypothermic circulatory arrest is associated with an increased incidence of postoperative electroencephalographic seizures. J Thorac Cardiovasc Surg. 2005;130:1278-1286.

    Article  PubMed  Google Scholar 

  45. Perlman JM, Volpe JJ. Seizures in the preterm infant: effects on cerebral blood flow velocity, intracranial pressure, and arterial blood pressure. J Pediatr. 1983;102:288-293.

    Article  PubMed  CAS  Google Scholar 

  46. Goldberg RN, Goldman SL, Ramsay RE, et al. Detection of seizure activity in the paralyzed neonate using continuous monitoring. Pediatrics. 1982;69:583-586.

    PubMed  CAS  Google Scholar 

  47. Lou H, Friss-Hansen B. Arterial blood pressure elevations during motor activity and epileptic seizures in the newborn. Acta Paediatra Scan. 1979;68:803-806.

    Article  CAS  Google Scholar 

  48. Laroia N, Guillet R, Burchfiel J, et al. EEG background as predictor of electrographic seizures in high-risk neonates. Epilepsia. 1998;39:545-551.

    Article  PubMed  CAS  Google Scholar 

  49. Clancy RR. Prolonged electroencephalogram monitoring for seizures and their treatment. Clin Perinatol. 2006;33:649-665.

    Article  PubMed  Google Scholar 

  50. Levy SR, Abroms IF, Marshall PC, et al. Seizures and cerebral infarction in the full-term newborn. Ann Neurol. 1985;17:366-370.

    Article  PubMed  CAS  Google Scholar 

  51. du Plessis A, Kramer U, Jonas R, et al. West syndrome following deep hypothermic cardiac surgery. Pediatr Neurol. 1994;11:246-251.

    Article  PubMed  Google Scholar 

  52. Mahle WT, Clancy RR, Moss EM, et al. Neurodevelopmental outcome and lifestyle assessment in school-aged and adolescent children with hypoplastic left heart syndrome. Pediatrics. 2000;105:1082-1089.

    Article  PubMed  CAS  Google Scholar 

  53. Bellinger DC, Jonas RA, Rappaport LA, et al. Developmental and neurologic status of children after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. N Engl J Med. 1995;332:549-555.

    Article  PubMed  CAS  Google Scholar 

  54. Bellinger DC, Wypij D, Kuban KC, et al. Developmental and neurological status of children at 4 years of age after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. Circulation. 1999;100:526-532.

    Article  PubMed  CAS  Google Scholar 

  55. Gaynor JW, Jarvik GP, Bernbaum J, et al. The relationship of postoperative electrographic seizures to neurodevelopmental outcome at 1 year of age after neonatal and infant cardiac surgery. J Thorac Cardiovasc Surg. 2006;131:181-189.

    Article  PubMed  Google Scholar 

  56. Painter MJ, Scher MS, Stein AD, et al. Phenobarbital compared with phenytoin for the treatment of neonatal seizures. N Eng J Med. 1999;341:485-489.

    Article  CAS  Google Scholar 

  57. Castro Conde JR, Hernandez Borges AA, Domenech Martinez E, et al. Midazolam in neonatal seizures with no response to Phenobarbital. Neurology. 2005;64:876-879.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Neurology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA

    Robyn A. Filipink

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  1. Robyn A. Filipink
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  2. Michael J. Painter
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Correspondence to Robyn A. Filipink .

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Editors and Affiliations

  1. Children's Hospital, Pittsburgh, 5th Ave. 3705, Pittsburgh, 15213, USA

    Ricardo Munoz

  2. School of Medicine, Children's Hospital, University of Pittsburgh, Fifth Ave. 3705, Pittsburgh, 15213, USA

    Victor Morell

  3. Chemin de Normanie 2, Geneve, 1206, Switzerland

    Eduardo Cruz

  4. Children's Hospital, Pittsburgh, 5th Ave. 3705, Pittsburgh, 15213, USA

    Carol Vetterly

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Filipink, R.A., Painter, M.J. (2009). Neurogical Complications: Intracranial Bleeding, Stroke and Seizures. In: Munoz, R., Morell, V., Cruz, E., Vetterly, C. (eds) Critical Care of Children with Heart Disease. Springer, London. https://doi.org/10.1007/978-1-84882-262-7_61

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  • DOI: https://doi.org/10.1007/978-1-84882-262-7_61

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84882-261-0

  • Online ISBN: 978-1-84882-262-7

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