Division of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
Divisions of Pediatric Neurology and Vascular Neurology, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Neurocrit Care. 2023 Apr;38(2):486-503. doi: 10.1007/s12028-023-01689-2. Epub 2023 Feb 24.
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.
Narrative review of the literature on neuromonitoring in children with cerebrovascular disorders.
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.
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.
脑血管疾病是儿童发病率和死亡率的重要原因。患有缺血性或出血性中风或脑静脉窦血栓形成的儿童的急性护理重点是稳定患者，确定损伤的原因，并预防继发性损伤。在这里，我们回顾了在动脉缺血性中风、非创伤性颅内出血和脑静脉窦血栓形成的儿科患者的护理中使用有创和无创神经监测方式。
对儿童脑血管疾病神经监测文献的叙述性回顾。
神经影像学、近红外光谱、经颅多普勒超声、连续和定量脑电图、有创颅内压监测以及多模态神经监测可增强脑血管疾病儿童的急性护理。神经监测可以在动脉缺血性中风、颅内出血或静脉窦血栓形成后，在进行性损伤的早期识别中发挥重要作用，包括复发性梗死或梗死扩大、新的或复发性出血、血管痉挛和迟发性脑缺血、癫痫持续状态和颅内压升高，等等，这反过来又可以促进治疗计划的实时调整。
在过去的几年中，我们对儿科脑血管疾病的认识有了显著提高，部分原因是神经监测方式的进步使我们能够更好地了解这些疾病。作为一个领域，我们现在有能力利用神经监测能力的进步来确定如何最好地管理和治疗儿童急性脑血管疾病。
