Publications by authors named "Dana Harrar"

Objectives: Traumatic brain injury (TBI) is a leading cause of pediatric morbidity and mortality. This study first investigates clinical characteristics and continuous electroencephalography (cEEG) parameters associated with short-term functional outcomes in pediatric patients following TBI. Second, we use these data for a hypothesis-generating model about outcomes.

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We present a toddler with acute sphenoid sinusitis presenting as status epilepticus with fever, intracranial abscess and meningitis. Cerebrospinal fluid analysis suggested bacterial meningitis, but polymerase chain reaction test was positive for human herpes virus 6. We highlight diagnosis and treatment of this uncommon condition.

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Objective: To describe electroencephalographic (EEG) changes in pediatric patients with cerebral edema after cardiac arrest.

Methods: A retrospective study of patients admitted to the pediatric intensive care unit from July 2021 to January 2023. We included patients with cardiac arrest and changes in EEG background with clinical changes and/or neuroimaging consistent with cerebral edema.

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Despite high mortality rates, pediatric extracorporeal membrane oxygenation (ECMO) redeployments are frequently discussed in everyday clinical care. We aim to investigate predictors of mortality in those patients. Clinical data from a single pediatric center were retrospectively analyzed.

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Introduction And Problem Statement: There is a need for structured EEG education opportunities to enhance neurology resident education. To address this need, the American Epilepsy Society (AES) supported the development and implementation of both synchronous and asynchronous EEG courses.

Objectives: To produce EEG curricula that enhance resident EEG learning, increase interest in EEG and improve participants' knowledge, and to ensure that courses were highly used and available to the broadest range of learners.

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We convened an electroencephalography and epilepsy think tank in Blantyre, Malawi, bringing together American pediatric neurologist clinical researchers and Malawian clinicians. We worked with the aim of improving care for children with seizures and epilepsy in southern Malawi. By sharing and discussing ideas, six United States-based researchers and six Malawian end users developed consensus for directions of both current and future clinical research activities.

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Article Synopsis
  • The study aimed to identify clinical and EEG predictors of epilepsy in pediatric patients who experienced spontaneous intracerebral hemorrhage due to arteriovenous malformation (AVM) rupture, as well as to evaluate the occurrence of electrographic seizures.
  • Researchers conducted a retrospective review of pediatric patients over 11 years, examining medical records to assess seizure types categorized as acute, subacute, and remote, along with outcomes like mortality and epilepsy development post-discharge.
  • Of the 43 patients reviewed, 16% had a clinical seizure before EEG, 16% were later diagnosed with epilepsy, and remote seizures significantly correlated with epilepsy development, highlighting that seizures more than 30 days after the rupture pose a greater risk for long-term epilepsy
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Here we describe a pediatric patient with febrile infection-related epilepsy syndrome with a good functional and neurologic outcome after treatment with early and aggressive cytokine-directed immunomodulatory therapy and a seizure management strategy that intentionally avoided a barbiturate coma. A 5-year-old previously healthy male presented with staring, behavioral arrest, and encephalopathy evolving to super-refractory status epilepticus. He had had onset of fever 5 days prior.

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Background: Acute metabolic crises in inborn errors of metabolism (such as urea cycle disorders, organic acidemia, maple syrup urine disease, and mitochondrial disorders) are neurological emergencies requiring management in the pediatric intensive care unit (PICU). There is a paucity of data pertaining to electroencephalograms (EEG) characteristics in this cohort. We hypothesized that the incidence of background abnormalities and seizures in this cohort would be high.

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Background: The ictal-interictal continuum (IIC) consists of several electroencephalogram (EEG) patterns that are common in critically ill adults. Studies focused on the IIC are limited in critically ill children and have focused primarily on associations with electrographic seizures (ESs). We report the incidence of the IIC in the pediatric intensive care unit (PICU).

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Article Synopsis
  • - A study examined 5 boys aged 8-17 with GFAP astrocytopathy, a rare type of meningoencephalomyelitis, identifying key symptoms like fever, headache, vomiting, weakness, tremor, and ataxia.
  • - MRI scans revealed spinal cord abnormalities in some patients, with most showing an increase in white blood cells in their cerebral spinal fluid; all tested negative for cancer.
  • - Although three patients became comatose, all received immunosuppressant treatment and improved by discharge, but none returned to their original health levels, highlighting GFAP astrocytopathy as an important condition for pediatric care.
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Article Synopsis
  • Surgical revascularization can lower long-term stroke risks in children with moyamoya arteriopathy, but increases stroke risk during surgery, highlighting a need for improved perioperative care practices.
  • Experts used a modified Delphi process to gather insights from 30 specialists on effective management strategies for these patients, culminating in 39 consensus statements.
  • Key recommendations include preadmission for high-risk children, mandatory intravenous fluids around surgery, continuous aspirin usage, and rigorous monitoring of vital signs and neurological status post-surgery.
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We describe a 13-year-old female with influenza complicated by bilateral vision loss due to retinal and lateral geniculate nucleus (LGN) infarctions. She continues to have near-total vision loss in her left eye 3.5 years later.

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Background: Arterial ischemic stroke in children comes with the potential for morbidity and mortality and can result in high cost of care and decreased quality of life among survivors. Children with arterial ischemic stroke are increasingly being treated with mechanical thrombectomy, but little is known about the risks and benefits 24 hours after a patient's last known well (LKW) time.

Methods: A 16-year-old female presented with acute onset of dysarthria and right hemiparesis with LKW time 22 hours prior.

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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.

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Background: Continuous electroencephalography (cEEG) is commonly used for neuromonitoring in pediatric intensive care units (PICU); however, there are barriers to real-time interpretation of EEG data. Quantitative EEG (qEEG) transforms the EEG signal into time-compressed graphs, which can be displayed at the bedside. A survey was designed to understand current PICU qEEG use.

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Background: Although seizures are known to occur in children with moyamoya arteriopathy, data regarding characteristics, prevalence, and predictive factors for their development are less established. This study aimed to systematically review literature addressing seizures, epilepsy, and electroencephalography findings in the pediatric moyamoya population.

Methods: A scoping review was performed by searching PubMed and Ovid:Embase databases for articles that described seizures, epilepsy, and electroencephalography findings in patients aged 0 to 21 years with moyamoya arteriopathy.

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The field of pediatric stroke has historically been hampered by limited evidence and small patient cohorts. However the landscape of childhood stroke is rapidly changing due in part to increasing awareness of the importance of pediatric stroke and the emergence of dedicated pediatric stroke centers, care pathways, and alert systems. Acute pediatric stroke management hinges on timely diagnosis confirmed by neuroimaging, appropriate consideration of recanalization therapies, implementation of neuroprotective measures, and attention to secondary prevention.

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Objective: To determine the prevalence of and risk factors for cerebral sinus venous thrombosis (CSVT) in neonates undergoing congenital heart disease (CHD) repair.

Study Design: Neonates who had CHD repair with cardiopulmonary bypass and postoperative brain magnetic resonance imaging (MRI) between 2013 and 2019 at a single tertiary care center were identified from institutional databases. Demographic, clinical, and surgical data were abstracted from these databases and from the medical record; 278 neonates with CHD had cardiopulmonary bypass, 184 of whom had a postoperative brain MRI.

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Article Synopsis
  • Data from early in the pandemic showed that 0.62% of children hospitalized with COVID-19 experienced an acute arterial ischemic stroke (AIS), and researchers wanted to see if this percentage remained stable over time.
  • They surveyed 61 centers in 21 countries to gather data on the incidence of AIS in children with SARS-CoV-2 from June to December 2020, assessing the role of COVID-19 as a stroke risk factor.
  • Findings indicated that the risk of AIS in pediatric COVID-19 patients decreased to 0.32%, with SARS-CoV-2 identified as the main risk factor in a small number of cases, while elevated inflammatory markers were prevalent in those affected.
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