Central nervous system anoxic-ischemic insult in children due to near-drowning.

Taylor, S B; Quencer, R M; Holzman, Bernard H.; Naidich, Thomas P.

doi:10.1148/radiology.156.3.4023222

Cited by 30 publications

(7 citation statements)

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“…An initially normal CT in a comatose patient should not be re-assuring [138, 139]. Comatose pediatric drowning victims who have an initial abnormal head CT or a normal CT with a subsequent abnormal CT have poor outcome [139].…”

Section: Neuromonitoringmentioning

confidence: 99%

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Brain Resuscitation in the Drowning Victim

et al. 2012

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Drowning is a leading cause of accidental death. Survivors may sustain severe neurologic morbidity. There is negligible research specific to brain injury in drowning making current clinical management non-specific to this disorder. This review represents an evidence-based consensus effort to provide recommendations for management and investigation of the drowning victim. Epidemiology, brain-oriented prehospital and intensive care, therapeutic hypothermia, neuroimaging/monitoring, biomarkers, and neuroresuscitative pharmacology are addressed. When cardiac arrest is present, chest compressions with rescue breathing are recommended due to the asphyxial insult. In the comatose patient with restoration of spontaneous circulation, hypoxemia and hyperoxemia should be avoided, hyperthermia treated, and induced hypothermia (32–34 °C) considered. Arterial hypotension/hypertension should be recognized and treated. Prevent hypoglycemia and treat hyperglycemia. Treat clinical seizures and consider treating non-convulsive status epilepticus. Serial neurologic examinations should be provided. Brain imaging and serial biomarker measurement may aid prognostication. Continuous electroencephalography and N20 somatosensory evoked potential monitoring may be considered. Serial biomarker measurement (e.g., neuron specific enolase) may aid prognostication. There is insufficient evidence to recommend use of any specific brain-oriented neuroresuscitative pharmacologic therapy other than that required to restore and maintain normal physiology. Following initial stabilization, victims should be transferred to centers with expertise in age-specific post-resuscitation neurocritical care. Care should be documented, reviewed, and quality improvement assessment performed. Preclinical research should focus on models of asphyxial cardiac arrest. Clinical research should focus on improved cardiopulmonary resuscitation, re-oxygenation/reperfusion strategies, therapeutic hypothermia, neuroprotection, neurorehabilitation, and consideration of drowning in advances made in treatment of other central nervous system disorders.

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Section: Neuromonitoringmentioning

confidence: 99%

“…Comatose pediatric drowning victims who have an initial abnormal head CT or a normal CT with a subsequent abnormal CT have poor outcome [139]. Retrospective studies concluded that if there was no clinical evidence of trauma, CT is not necessary [138, 139]. Despite this, intracranial hemorrhage may be present following CA [140].…”

Section: Neuromonitoringmentioning

confidence: 99%

Brain Resuscitation in the Drowning Victim

et al. 2012

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“…Taylor et al found that 12 of 17 children (71%) had normal CTs following a drowning event (7). Abnormal findings consisted of either diffuse edema and/or bilateral basal ganglia infarction.…”

Section: Discussionmentioning

confidence: 99%

“…No large studies exist that describe the cranial computed tomography (CT) findings in children with drowning; only a few, small retrospective reviews examine this subject (6,7). The primary purpose of this study is to better define both the patterns and incidence of cranial CT abnormalities found in children following submersion injury.…”

mentioning

confidence: 99%

Cranial computed tomographic findings in a large group of children with drowning: Diagnostic, prognostic, and forensic implications*

Rafaat

Spear

Kuelbs

et al. 2008

Pediatric Critical Care Medicine

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These data from the largest study of CT findings in pediatric drowning clearly illustrate that following submersion injury, intra- or extra-axial bleeding is not seen on cranial CT. Furthermore, an abnormal CT scan at any time was associated with a poor outcome (death or persistent vegetative state). The CT findings and the presenting Glasgow Coma Scale of patients with drowning differ from those of patients who have suffered abusive head trauma.

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“…Early prognostic of good outcome versus significant neurological deficit or death is important for correctly stratifying patient management 1,2 . Magnetic resonance image (MRI) and computed tomographic findings of acute hypoxia ischemic injury are often subtle [1][2][3] . we describe the findings of early proton magnetic resonance spectroscopy ( 1 H MRS) that helped to predict the prognosis.…”

mentioning

confidence: 99%

Prognostic value of proton magnetic resonance spectroscopy findings in near drowning patients: reversibility of the early metabolite abnormalities relates with a good outcome

Aragão

Law

Netto

et al. 2009

Arq. Neuro-Psiquiatr.

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-In two children with near drowning hypoxic encephalopathy and normal-appearing structural MRI, acute proton magnetic resonance spectroscopy ( 1 H MRS) showed biochemical alterations that correctly indicated prognosis and helped to guide management decisions. Elevation of the lipid-lactate and glutamineglutamate peaks, on the early (72 hour) 1 H MRS, predicts a poor prognosis. Absence of lipid-lactate and glutamine-glutamate peaks on the early 1 H MRS and reversibility of early mild metabolite abnormalities on follow up examination relates with good outcome. The term "near drowning" signifies patient survival for more than 24-hours after cardiorespiratory arrest due to submersion. Early prognostic of good outcome versus significant neurological deficit or death is important for correctly stratifying patient management 1,2 . Magnetic resonance image (MRI) and computed tomographic findings of acute hypoxia ischemic injury are often subtle 1-3 . we describe the findings of early proton magnetic resonance spectroscopy ( 1 H MRS) that helped to predict the prognosis. MetHodIn two children with hypoxic-ischemic insult due to fresh water near drowning and normal-appearing structural MRI are studied.In each patient single-voxel 1.5 Tesla 1 H MRS was performed in the median biparietal-occipital gray matter using a stimulated echo acquisition mode (STEAM) technique with repetition time: 1,500 ms, echo time: 30 ms, eight excitations, volume of interest: 6 cm 3 , and acquisition time: 7 minutes. The 1 H MRS data were compared with the standard MRI study obtained at the same session using non contrast sagittal T1-weighted images (wI), coronal and axial T2-wI, axial T2*-wI, axial T2-FlAIR and axial diffusion-wI, followed by gadolinium-enhanced axial T1-wI. results Case 1This 3-year-old girl suffered near drowning in a swimming pool. She experienced cardiorespiratory arrest, was

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Central nervous system anoxic-ischemic insult in children due to near-drowning.

Cited by 30 publications

References 0 publications

Brain Resuscitation in the Drowning Victim

Brain Resuscitation in the Drowning Victim

Cranial computed tomographic findings in a large group of children with drowning: Diagnostic, prognostic, and forensic implications*

Prognostic value of proton magnetic resonance spectroscopy findings in near drowning patients: reversibility of the early metabolite abnormalities relates with a good outcome

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