title: Decompressive hemicraniectomy for acute disseminated encephalomyelitis: case report.
abstract: OBJECTIVE
  Acute disseminated encephalomyelitis (ADEM) varies widely in symptoms and severity. Some cases are associated with massive life-threatening cerebral edema refractory to conventional medical management.
  
  
  METHODS
  A 51-year-old woman with ADEM who developed severe brain swelling and herniation despite aggressive medical management is described.
  
  
  METHODS
  A decompressive hemicraniectomy and durotomy led to rapid improvement and an excellent outcome.
  
  
  CONCLUSIONS
  This case report reinforces the place of this procedure in the armamentarium of treatment options for patients with medically refractory brain swelling and elevated intracranial pressure caused by ADEM. The potential for an increase in the incidence of ADEM with more frequent smallpox vaccinations emphasizes the significance of redefining the full range of management options for this treatable disease.
authors.affiliation: Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Refai
authors.forename: Max C
authors.initials: MC
authors.lastname: Lee
authors.forename: Fernando D
authors.initials: FD
authors.lastname: Goldenberg
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Frank
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging; D003399:Craniotomy / Q000379:methods*; D019299:Decompression, Surgical / Q000379:methods*; D004673:Encephalomyelitis, Acute Disseminated / Q000601:surgery*; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome