Neurocritical Care

Conditions We Treat


Acute flaccid myelitis (AFM) is a rare but serious illness likely caused by a virus that attacks the spinal cord and nerve cells. Children may have weakness in the arm, leg and facial muscles, and difficulty swallowing. Muscles that control breathing can also be affected. Upon hospitalization, early intervention of physical and occupational therapy may help to restore muscle function, although it takes time. Surgical options may include nerve or tendon transfer. There is no cure for AFM.Acute flaccid myelitis (AFM) is a rare but serious illness likely caused by a virus that attacks the spinal cord and nerve cells. Children may have weakness in the arm, leg and facial muscles, and difficulty swallowing. Muscles that control breathing can also be affected. Upon hospitalization, early intervention of physical and occupational therapy may help to restore muscle function, although it takes time. Surgical options may include nerve or tendon transfer. There is no cure for AFM.

An acute ischemic stroke is a rare condition caused by insufficient blood flow to the brain. Call 911 immediately if your child is having symptoms that include slurred speech, trouble walking, weakness on one side of the body and seizure. Treatment will begin in the emergency center. Long-term care will likely include physical, occupational and speech/language therapy. 

Acute encephalopathy is the sudden onset of severe inflammation of the brain usually associated with a viral infection. This leads to changes in a child's neurological condition, including mental confusion and seizures. Symptoms should be treated immediately in the hospital.

Autoimmune encephalitis is a rare condition in which antibodies produced by the body’s immune system attack the brain, causing inflammation and various complications that include behavioral symptoms and movement disorders. Early treatment protocols can reduce the chances of long-term complications such as coma or permanent brain injury. 

Meningitis and meningoencephalitis are inflammations of the meninges, which are the thin membranes that surround the brain and the spinal cord. They are usually caused by a bacterial or viral infection that invades the cerebral spinal fluid and inflames the meninges. Meningoencephalitis is a combination of encephalitis and meningitis. The earlier the treatment is initiated, the better the child's outcome. 

These tumors are abnormal growths that form in the brain, spinal cord and nerves. They can be benign (not cancerous) or malignant (cancerous). In either case, a tumor can cause the brain, spinal cord and nerves to not function properly. Brain tumors include astrocytoma, craniopharyngioma, low-grade glioma and medulloblastoma, among others

This swelling of the brain is a serious complication of diabetic ketoacidosis – when acids called ketones build up in the urine. The symptoms come on quickly and include thirst, frequent urination and confusion. If at home testing shows your child has high blood sugar levels and high ketone levels in urine, treatment should be sought immediately.

The network of venous sinuses collect and drain oxygen-depleted blood in the cranium and return it to the heart. Cerebral venous sinus thrombosis means that a blood clot is preventing blood from draining out of the brain. The resulting pressure buildup in the blood vessels can lead to bleeding (hemorrhage) and swelling in the brain. These are precursors of a stroke. Treatment should begin immediately in a hospital. 

A coma is a state of unconsciousness in which the child’s brain is functioning at its lowest level of alertness. Comas can be caused by numerous factors including traumatic brain injury, a lack of oxygen, and a stroke or seizures, among other causes. Immediate medical attention is necessary in the pediatric emergency department or pediatric intensive care unit. 

With multiple sclerosis and other demyelinating diseases, the immune system targets the brain, spinal cord and optic nerves. These autoimmune disorders damage myelin, the protective covering that surrounds nerves and nerve tissue. Demyelinating diseases affect nerves in various parts of the body. Because no cure is available, treatments focus on preventing further demyelination. 

This is a rare condition with which a child who has had a febrile (fever) illness such as a cold or flu experiences seizures 24 hours to 2 weeks later. The seizures become more frequent and can ultimately be continuous or nearly continuous seizure activity. FIRES does not respond to most treatments, including medications, and will cause the child to have chronic epilepsy.

Guillain-Barré syndrome is a temporary disorder that harms the nerves, which can result in muscle weakness and even temporary muscle paralysis. The key to medically managing GBS is early detection. Because the condition can be life threatening, a child with GBS requires immediate hospitalization in the intensive care unit. The majority of children diagnosed with GBS experience a full recovery. 

Hypoxic ischemic encephalopathy (HIE) occurs when the brain experiences a decrease in oxygen or blood flow before or after birth. HIE affects the central nervous system and may cause the child to have neurological or developmental problems such as developmental delay, cerebral palsy or epilepsy. Treatment depends on numerous factors including how severe the condition is. 

This is a dangerous condition that means pressure has increased inside the portion of the skull that surround the brain. It can be caused by a brain injury or medical condition such as bleeding in the brain, a brain tumor, hydrocephalus or stroke. If your child has symptoms that include severe headache, vomiting, blurred vision or seizure, seek immediate medical attention. 

An intracerebral hemorrhage – bleeding in the brain – is a type of stroke that results from burst blood vessels. It is usually caused by blood vessel anomalies, blood vessel damage or blood clots. Bleeding occurs quickly and can quickly become severe. Generally, there are no warning signs. Call 911 if you suspect your child is having this or any type of stroke. 

When blood enters into the ventricles, which are fluid-filled area in the brain that contain cerebral spinal fluid, the condition is referred to as intraventricular hemorrhage (IVH). This bleeding can ultimately lead to hydrocephalus or irreversible brain injury. It is most common in premature babies due to the underdeveloped and frail state of the blood vessels in their brains. An infant’s prognosis depends on the severity of bleeding. 

Myasthenia gravis (MG) is a rare neuromuscular disorder that causes muscles strength to fluctuate throughout the day, usually worsening after periods of activity and improving after periods of rest. An exacerbation is an increase in frequency or severity of symptoms. Families with children who suffer from MG should contact the child’s physician about changes in MG symptoms or other health issues. 

Hundreds of conditions can affect a child’s central nervous system – the brain, spinal cord and nerves – that are treated by neurosurgeons. These include epilepsy, brain tumors, moyamoya disease (blocked arteries at the base of the brain, which can cause strokes) and chiari malformation (a problems in which the brain presses into the spinal canal).

Children are considered to have refractory status epilepsy when they have continuous or frequent seizures that do not respond to their epilepsy medicines. Refractory status epilepsy generally strikes without an identifiable cause; however it can be the result of an acute brain injury or another serious medical illness. Super-refractory status epilepticus is a status epilepticus that continues for more than 24 hours despite treatment. Both conditions are considered life threatening. Treatment in an intensive care unit is necessary.

With scoliosis and other spinal deformities, the spine becomes curved or twisted and can cause uneven shoulders, breathing difficulties, back pain, and a humpback or swayback appearance. If left untreated, these conditions can get worse over time. These diseases include kyphotisis, lordodis, and spondylolsis and spondylolisthesis.

Because of the number of nerves held within the spinal cord, an injury to it can affect critical functions throughout the body including the loss of sensation and function in the lower half of the body (paraplegia) or from the chest down (quadriplegia). These are potentially life-threatening injuries. Call 911 if your child has a spinal cord injury.

Status epilepticus is a life-threatening condition defined as a seizure lasting longer than five minutes that does not stop on its own and from which the patient does not wake.. Status epilepticus can permanently affect cognitive abilities and cause brain damage and even death. Both types of status epilepticus – convulsive or nonconvulsive – require immediate medical attention.

The subarachnoid space is part of the layer that separates the brain and the cranium. A subarachnoid hemorrhage occurs when a blood vessel on the brain ruptures. The resulting buildup of blood causes increasing pressure on the brain that can result in serious complications. A subarachnoid hemorrhage is a medical emergency – seek immediate treatment for your child to help reduce their risk for permanent brain damage.

A subdural hemorrhage is ongoing bleeding near the brain generally caused by an injury to the brain. Symptoms include severe headache, nausea and vomiting, trouble with vision and speech, and difficulty walking. Like other neurocritical conditions described here, bleeding in the brain is a medical emergency. 

A traumatic brain injury (TBI) occurs from direct or indirect blows to the head that disrupt normal brain function. Skull fractures, concussions and contusions are types of TBIs. TBIs are rated as mild, moderate or severe based on factors such as the nature and extent of the injury, how long the child is unconscious and if the child experiences amnesia. Treatment should be sought immediately and will depend on the severity of the injury and the conditions that result from it.