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Neuromonitoring in Children with Cerebrovascular Disorders

  • Pediatric Neuromonitoring
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Background

Cerebrovascular disorders are an important cause of morbidity and mortality in children. The acute care of a child with an ischemic or hemorrhagic stroke or cerebral sinus venous thrombosis focuses on stabilizing the patient, determining the cause of the insult, and preventing secondary injury. Here, we review the use of both invasive and noninvasive neuromonitoring modalities in the care of pediatric patients with arterial ischemic stroke, nontraumatic intracranial hemorrhage, and cerebral sinus venous thrombosis.

Methods

Narrative review of the literature on neuromonitoring in children with cerebrovascular disorders.

Results

Neuroimaging, near-infrared spectroscopy, transcranial Doppler ultrasonography, continuous and quantitative electroencephalography, invasive intracranial pressure monitoring, and multimodal neuromonitoring may augment the acute care of children with cerebrovascular disorders. Neuromonitoring can play an essential role in the early identification of evolving injury in the aftermath of arterial ischemic stroke, intracranial hemorrhage, or sinus venous thrombosis, including recurrent infarction or infarct expansion, new or recurrent hemorrhage, vasospasm and delayed cerebral ischemia, status epilepticus, and intracranial hypertension, among others, and this, is turn, can facilitate real-time adjustments to treatment plans.

Conclusions

Our understanding of pediatric cerebrovascular disorders has increased dramatically over the past several years, in part due to advances in the neuromonitoring modalities that allow us to better understand these conditions. We are now poised, as a field, to take advantage of advances in neuromonitoring capabilities to determine how best to manage and treat acute cerebrovascular disorders in children.

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Fig. 1
Fig. 2

(Reproduced with permission from Tomko SR, Hahn C, Guerriero RM, Quantitative EEG in the pediatric intensive care unit, in Sansevere AJ, Harrar DB, Atlas of pediatric and neonatal ICU EEG, New York: NY, Demos Medical Publishing. Copyright Springer Publishing Company, LLC.; 2021. p. 363)

Fig. 3
Fig. 4
Fig. 5

(Reproduced with permission from Tomko SR, Hahn C, Guerriero RM, Quantitative EEG in the pediatric intensive care unit, in Sansevere AJ, Harrar DB, Atlas of pediatric and neonatal ICU EEG, New York: NY, Demos Medical Publishing. Copyright Springer Publishing Company, LLC.; 2021. p. 356)

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Authors and Affiliations

  1. Division of Neurology, Children’s National Hospital, George Washington University School of Medicine, Washington, DC, USA

    Dana B. Harrar & Arnold J. Sansevere

  2. Divisions of Pediatric Neurology and Vascular Neurology, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Lisa R. Sun

  3. Division of Child Neurology, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA

    J. Bradley Segal & Sarah Lee

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Contributions

Substantial contributions to conception and design, acquisition of data, and analysis and interpretation of data: HDB, SLR, and SAJ. Substantial contributions to acquisition of data and analysis and interpretation of data: SJB and LS. Drafting the article and revising it critically for important intellectual content: HDB, SLR, SJB, and LS. Revising the article critically for important intellectual content: SAJ. Final approval of the version to be published: HDB, SLR, SJB, LS, and SAJ. Agreement to be accountable for all aspects of the work: HDB, SLR, SJB, LS, and SAJ.

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Correspondence to Dana B. Harrar.

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DH and AJS receive royalties from Springer Publishing Company, LLC for: Sansevere AJ, Harrar DB, eds. Atlas of pediatric and neonatal intensive care unit EEG, New York: NY, Demos Medical Publishing. Copyright Springer Publishing Company, LLC.; 2021. LRS is supported by a career development award from the American Heart Association: Clinical, Radiographic, and Hemodynamic Predictors of Childhood Moyamoya Arteriopathy Progression and Surgical Risk. The remaining authors (JBS, SL) have no conflicts of interest to disclose.

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Harrar, D.B., Sun, L.R., Segal, J.B. et al. Neuromonitoring in Children with Cerebrovascular Disorders. Neurocrit Care 38, 486–503 (2023). https://doi.org/10.1007/s12028-023-01689-2

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