Topical nitroglycerin in newborns with ischemic injuries: A systematic review.

BACKGROUND: Arterial catheterization is frequently performed in neonatal intensive care units with an inherent risk of peripheral ischemic injury, especially in preterm infants. The treatment options following vascular damage involve invasive and non-invasive modalities. The primary objective of this systematic review was to evaluate the evidence of the use of topical nitroglycerine (TNG) either alone or as adjunctive therapy. The secondary aim was to develop an approach to the treatment of catheter induced ischemia in infants based on the available evidence. METHODS: A comprehensive search was conducted of available databases for relevant articles that involved the treatment of peripheral tissue ischemia in neonates with the use of TNG. Citations were restricted to human subjects. RESULTS: Six hundred and eighty-nine articles were identified, and twenty-seven case reports and case series were compatible with the inclusion and exclusion criteria. Sixty-eight infants out of the 76 published cases (89%) experienced a favorable outcome and 79% (n = 60) demonstrated complete recovery with the topical application of TNG to the ischemic site. CONCLUSION: The available evidence demonstrates that TNG is effective for the treatment of peripheral ischemia in neonates after standard conservative measures have failed. However, due to the absence of robust evidence for this therapeutic modality, there are no uniform guidelines regarding the frequency, duration, and safety of TNG use. Planning the management of peripheral ischemia in neonates with TNG should be a multidisciplinary decision that includes close surveillance of blood pressure, methemoglobin levels, and follow up cranial ultrasound.

Microsurgery for a ruptured intracranial aneurysm in a 3-year-old child: A case report.

INTRODUCTION: Pediatric intracranial aneurysms are rare, with some different characteristics from those in adults. Here, we present a case of distal anterior cerebral artery aneurysm which we believe the first case from Vietnam. PRESENTATION OF CASE: A 3 years old boy presented with headache, lethargic and hemiparesis was diagnosed ruptured distal anterior cerebral artery aneurysm with CTA. 10 days before admission in our hospital, the toddler was admitted in local hospital with diagnosis of SAH without more accurate findings. Clipping microsurgery of aneurysms with left interhemispheric approach was done with good outcome. DISCUSSION: The epidermiology, presentation and diagnosis and strategy of treatments as well as their outcomes were discussed. We also discussed our thoughts about our case within the limited-resource condition such as in Vietnam. CONCLUSION: Pediatric intracranial anerusyms are rare but should be recognised in neurosurgical practice. Surgery is an effective treatment method.

Disruption to functional networks in neonates with perinatal brain injury predicts motor skills at 8 months.

Objective: Functional connectivity magnetic resonance imaging (fcMRI) of neonates with perinatal brain injury could improve prediction of motor impairment before symptoms manifest, and establish how early brain organization relates to subsequent development. This cohort study is the first to describe and quantitatively assess functional brain networks and their relation to later motor skills in neonates with a diverse range of perinatal brain injuries. Methods: Infants (n = 65, included in final analyses: n = 53) were recruited from the neonatal intensive care unit (NICU) and were stratified based on their age at birth (premature vs. term), and on whether neuropathology was diagnosed from structural MRI. Functional brain networks and a measure of disruption to functional connectivity were obtained from 14 min of fcMRI acquired during natural sleep at term-equivalent age. Results: Disruption to connectivity of the somatomotor and frontoparietal executive networks predicted motor impairment at 4 and 8 months. This disruption in functional connectivity was not found to be driven by differences between clinical groups, or by any of the specific measures we captured to describe the clinical course. Conclusion: fcMRI was predictive over and above other clinical measures available at discharge from the NICU, including structural MRI. Motor learning was affected by disruption to somatomotor networks, but also frontoparietal executive networks, which supports the functional importance of these networks in early development. Disruption to these two networks might be best addressed by distinct intervention strategies.

Neural correlates of executive attention in adults born very preterm.

Very preterm birth is associated with an increased prevalence of attention problems and may especially impair executive attention, i.e., top-down control of attentional selection in situations where distracting information interferes with the processing of task-relevant stimuli. While there are initial findings linking structural brain alterations in preterm-born individuals with attention problems, the functional basis of these problems are not well understood. The present study used an fMRI adaptation of the Attentional Network Test to examine the neural correlates of executive attention in a large sample of N = 86 adults born very preterm and/or with very low birth weight (VP/VLBW), and N = 100 term-born controls. Executive attention was measured by comparing task behavior and brain activations associated with the processing of incongruent vs. congruent arrow flanker stimuli. Consistent with subtle impairments of executive attention, the VP/VLBW group showed lower accuracy and a tendency for increased response times during the processing of incongruent stimuli. Both groups showed similar activation patters, especially within expected fronto-cingulo-parietal areas, but no significant between-group differences. Our results argue for a maintained attention-relevant network organization in high-functioning preterm born adults in spite of subtle deficits in executive attention. Gestational age and neonatal treatment variables showed associations with task behavior, and brain activation in the dorsal ACC and lateral occipital areas, suggesting that the degree of prematurity (and related neonatal complications) has subtle modulatory influences on executive attention processing.

A Case of Moyamoya Disease with Severe Preeclampsia / 대한주산의학회잡지

Moyamoya disease is a rare progressive cerebrovascular disorder caused by blocked arteries at the base of the brain in an area called the basal ganglia. The etiology and pathogenesis are unknown. Clinically, this disease is found with a higher incidence in young female, but there are few cases of moyamoya disease in pregnancy. The disease primarily affects children, but it can also occur in adults. in children. The first symptom of moyamoya disease is often stroke, or recurrent transient ischemic attack, frequently accompanied by muscular weakness or paralysis affecting one side of the body, or seizures. Adults most often experience a hemorrhagic stroke due to recurring blood clots in the affected brain vessels. The diagnosis of moyamoya disease is made on the basis of angiographic findings and threatment of Moyamoya disease is surgery, or conservative management. We report a case of moyamoya disease that presented as intracerebral hemorrhage and intraventricular hemorrhage during pregnancy complicating severe preeclampsia.

A Case of Moyamoya Disease with Severe Preeclampsia / 대한주산의학회잡지

Moyamoya disease is a rare progressive cerebrovascular disorder caused by blocked arteries at the base of the brain in an area called the basal ganglia. The etiology and pathogenesis are unknown. Clinically, this disease is found with a higher incidence in young female, but there are few cases of moyamoya disease in pregnancy. The disease primarily affects children, but it can also occur in adults. in children. The first symptom of moyamoya disease is often stroke, or recurrent transient ischemic attack, frequently accompanied by muscular weakness or paralysis affecting one side of the body, or seizures. Adults most often experience a hemorrhagic stroke due to recurring blood clots in the affected brain vessels. The diagnosis of moyamoya disease is made on the basis of angiographic findings and threatment of Moyamoya disease is surgery, or conservative management. We report a case of moyamoya disease that presented as intracerebral hemorrhage and intraventricular hemorrhage during pregnancy complicating severe preeclampsia.

Clinical Analysis of Hypertensive Intracranial Hemorrhage

367 patients with hypertensive intracranial hemorrhage, admitted to Masan Koryo neurosurgical department from Jan. 1988 to Dec. 1991, have been clinically analyzed. The results were as follows: 1) The group consisted of 176 males and 191 females. The peak age of the patients was at their 6th decade. Seasonal distribution of the incidence was peaked at spring and autumn. 2) 51.0% of these hemorrhage was located in putamen, 19.9% in thalamus, 12.5% in subcortex, 8.7% in cerebellum and 7.9% in brain stem. Patients with brain stem hemorrhage showed relatively poor prognosis compared with subcortex or cerebellar hemorrhage. 3) The level of consciousness at admission has significant relation to prognosis especially in non-operative group. 4) 130 patients underwent surgical treatment. In delayed operation group which was performed after at least 3 days from attack, good prognosis was obtained. 5) In 146 patients(39.8%), IVH was accompanied, which lead to poor prognosis. Especially in patients with thalamic hemorrhage, the incidence of IVH reached to 71.2%. 6) Overall outcome of 367 patients was good in 40.9%, and poor in 25.9%. Total motality rate was 33.2%.

Clinical Analysis of Hypertensive Intracranial Hemorrhage

367 patients with hypertensive intracranial hemorrhage, admitted to Masan Koryo neurosurgical department from Jan. 1988 to Dec. 1991, have been clinically analyzed. The results were as follows: 1) The group consisted of 176 males and 191 females. The peak age of the patients was at their 6th decade. Seasonal distribution of the incidence was peaked at spring and autumn. 2) 51.0% of these hemorrhage was located in putamen, 19.9% in thalamus, 12.5% in subcortex, 8.7% in cerebellum and 7.9% in brain stem. Patients with brain stem hemorrhage showed relatively poor prognosis compared with subcortex or cerebellar hemorrhage. 3) The level of consciousness at admission has significant relation to prognosis especially in non-operative group. 4) 130 patients underwent surgical treatment. In delayed operation group which was performed after at least 3 days from attack, good prognosis was obtained. 5) In 146 patients(39.8%), IVH was accompanied, which lead to poor prognosis. Especially in patients with thalamic hemorrhage, the incidence of IVH reached to 71.2%. 6) Overall outcome of 367 patients was good in 40.9%, and poor in 25.9%. Total motality rate was 33.2%.