[Superior vena cava syndrome: cause of secondary raise of intracranial pressure after traumatic brain injury].
A 41-year-old male is admitted for cranial trauma, having fallen from his own height. His state of extreme agitation imposes sedation, intubation and mechanical ventilation. A CT-scan reveals acute right hemispheric subdural haematoma, with discrete midline shift, and diffuse cerebral oedema. ICP-monitoring reveals severely increased intracranial pressure, which is responsive to routine medical neuroprotective treatment. Ten days after admission, sedation and neuroprotective treatment is gradually withdrawn. At the end of the second week, a secondary ascent in ICP is observed. The presence of a right subclavian central venous line, in combination with the strong inflammatory response and septic state of the patient, has caused bilateral thrombosis of subclavian and internal jugular veins. This superior vena cava syndrome (SVCS) impedes cerebral venous drainage, thus raising ICP. Within a few days of anticoagulant therapy, SVCS resolved. Impeded cerebral venous drainage is often forgotten or ignored as a cause of secondary elevated ICP. In face of persisting or recurring raised ICP and cerebral oedema, or apparition of communicant hydrocephalus, cerebral venous drainage should be investigated.
Département d'anesthésie-réanimation, groupe hospitalier Pitié-Salpêtrière, AP-HP, université Pierre-et-Marie-Curie, Paris 6, Paris, France.
I
I
Piteaud
L
L
Abdennour
C
C
Icke
I
I
Stany
T
T
Lescot
L
L
Puybasset
D000058:Accidental Falls; D000328:Adult; D001929:Brain Edema / Q000209:etiology / Q000628:therapy; D001930:Brain Injuries / Q000150:complications*; D002405:Catheterization, Central Venous / Q000009:adverse effects; D005094:Exophthalmos / Q000209:etiology; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006408:Hematoma, Subdural / Q000150:complications; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D019586:Intracranial Hypertension / Q000209:etiology* / Q000628:therapy; D007601:Jugular Veins; D008297:Male; D011014:Pneumonia / Q000150:complications; D011595:Psychomotor Agitation / Q000188:drug therapy; D013350:Subclavian Vein; D013479:Superior Vena Cava Syndrome / Q000150:complications*; D020246:Venous Thrombosis / Q000150:complications* / Q000188:drug therapy; D017287:Ventriculoperitoneal Shunt
D005343:Fibrinolytic Agents; D006993:Hypnotics and Sedatives
Syndrome cave supérieur: une cause secondaire d'élévation de la pression intracrânienne après traumatisme crânien grave.