RESUMO
Severe pediatric head injury has negative consequences for children of all ages. Even mild and moderate head injury results in residual impairment for school-age children and adolescents. Data are needed on the effects of these less severe insults, especially for preschoolers. Although research on the impact of the child's head injury on the parent-child relationship and family functioning is limited, the experience is likely to be very stressful for the parent and the family. Indeed, family integrity may be at risk. Research is needed that examines the effects of a child's head injury for the parent and the family over time and identifies factors related to these outcomes.
Assuntos
Cuidadores/psicologia , Traumatismos Craniocerebrais/psicologia , Traumatismos Craniocerebrais/reabilitação , Saúde da Família , Adulto , Criança , Efeitos Psicossociais da Doença , Traumatismos Craniocerebrais/enfermagem , Humanos , Pais/psicologia , Relações Profissional-FamíliaAssuntos
Guias de Prática Clínica como Assunto , Púrpura Trombocitopênica Idiopática/terapia , Corticosteroides/uso terapêutico , Exame de Medula Óssea , Criança , Contraindicações , Humanos , Imunoglobulinas Intravenosas/efeitos adversos , Imunoglobulinas Intravenosas/economia , Imunoglobulinas Intravenosas/uso terapêutico , Contagem de Plaquetas , Prednisona , Púrpura Trombocitopênica Idiopática/sangue , Recusa do Paciente ao TratamentoRESUMO
We studied the incidence, associated morbidity, and impact on health care charges of neurologic complications in 38 children with acute immune thrombocytopenic purpura (ITP) treated with intravenously administered IgG. Thirteen patients (34%) had transient neurologic complications, manifested by severe headache, nausea, and, rarely, aseptic meningitis. Computed tomography was performed in nine patients. Twelve patients were hospitalized longer than was required for their ITP alone. Neurologic complications caused by the IgG preparations used in the treatment of childhood ITP occur more frequently than has previously been suggested and may substantially increase the cost of treatment.
Assuntos
Imunoglobulinas Intravenosas/efeitos adversos , Doenças do Sistema Nervoso/etiologia , Púrpura Trombocitopênica Idiopática/complicações , Doença Aguda , Adolescente , Criança , Pré-Escolar , Custos e Análise de Custo , Feminino , Hospitalização/economia , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Imunoglobulinas Intravenosas/economia , Incidência , Lactente , Masculino , Doenças do Sistema Nervoso/economia , Doenças do Sistema Nervoso/epidemiologia , Púrpura Trombocitopênica Idiopática/economia , Púrpura Trombocitopênica Idiopática/terapiaRESUMO
PURPOSE: To assess movement of the medulla, tonsils, and upper cervical cord as well as that of the posterior fossa cerebrospinal fluid pathways in both normal subjects and those with Chiari I malformations. METHODS: Nine healthy volunteers and eight patients with Chiari I malformations were examined with phase-contrast cine MR. With a region-of-interest cursor, the directions and intensities of the brain and cerebrospinal fluid were assessed and intensity-versus-time graphs generated. RESULTS: Cerebrospinal fluid flow patterns of the patients with Chiari I malformations were normal except for absence of valleculla flow. In addition, increased velocities (10 times normal) of the tonsils of all patients with Chiari I malformations together with posterior movement of the medulla (rather than the expected anterior movement seen in volunteers) occurred. CONCLUSIONS: Increased velocities of the tonsils may be the result of the carotid systolic pulse being delivered to a structure (the tonsil) without the normal surrounding cerebrospinal fluid, resulting in impact of the tonsils in the confined foramen magnum and a consequent caudocranial recoil. An alternative explanation would include the Bernoulli effect caused by the confined location of the tonsils. There may be a decrease in the peak tonsillar velocities after surgery.