ABSTRACT
Posterior Fossa Syndrome (PFS) is a constellation of neurological, behavioural and psychological symptoms occurring in pediatric patients following surgical resection of posterior fossa brain tumours. The clinical presentation of PFS typically includes cerebellar mutism, bulbar dysfunction, ataxia, cranial nerve palsies, flaccid hemiparesis and emotional lability. The intent of this paper is to (a) provide an overview of PFS, (b) explore the case of a 16-year-old adolescent who presented with PFS following surgical resection of a fourth ventricle medulloblastoma, (c) reveal the complexity of her discharge, and (d) describe a discharge management framework used by the authors to guide the discharge process from a general pediatric unit in a tertiary care hospital.
Subject(s)
Abducens Nerve Diseases/etiology , Ataxia/etiology , Cerebral Ventricle Neoplasms/surgery , Medulloblastoma/surgery , Mutism/etiology , Patient Discharge , Abducens Nerve Diseases/rehabilitation , Adolescent , Ataxia/rehabilitation , Cerebral Ventricle Neoplasms/complications , Cerebral Ventricle Neoplasms/diagnosis , Cranial Fossa, Posterior , Craniotomy/adverse effects , Deglutition Disorders/etiology , Female , Fourth Ventricle , Humans , Hydrocephalus/etiology , Laminectomy/adverse effects , Medulloblastoma/complications , Medulloblastoma/diagnosis , Muscle Hypotonia/etiology , Mutism/rehabilitation , Patient Care Planning , Pediatric Nursing , SyndromeABSTRACT
The success of pediatric solid organ transplantation has been largely due to advancements in surgical techniques, technology, and preoperative and postoperative care. Potent immunosuppression continues to reduce the incidence and severity of rejection, and improve long-term survival. However, there is growing awareness of the role immunosuppression plays in contributing to the incidence of cytomegalovirus, Epstein-Barr virus, and Epstein-Barr virus-associated posttransplant lymphoproliferative disease. Herpes viruses such as these present as primary or recurrent disease and continue to be a significant source of morbidity and mortality in transplant recipients. This paper reviews the predictors of disease, clinical features, diagnosis, and methods of treatment of these major posttransplant viral syndromes. As part of the human herpes virus family, varicella-zoster virus will also be discussed. A case study shows the delicate balance of treating concomitant varicella infection at the time of transplantation.
