title: Death from cardiac failure in a child with ruptured cerebral arteriovenous malformation.
abstract: We present the case of a 13-year-old boy with a ruptured cerebral arteriovenous malformation who had rapidly progressive cardiac failure leading to death. Serial electrocardiograms, cardiac enzymes, echocardiograms, and pulmonary artery catheter data confirmed severe ventricular dysfunction related to myocardial ischemia and infarction. Cardiac dysfunction after cerebral insult is commonly described in adults with aneurysmal subarachnoid hemorrhage and has been termed "neurogenic stunned myocardium" because of its transient nature in most of patients. In children, cardiovascular dysfunction has been described in a few reports and only after traumatic brain injury. No deaths have been reported. This case report illustrates the potentially lethal consequences of cardiovascular dysfunction in children after ruptured cerebral arteriovenous malformation with subarachnoid hemorrhage. Compromised cardiac function should be considered during the early evaluation and management of these patients and supportive care instituted to limit secondary brain injury from poor perfusion.
authors.affiliation: Department of Pediatrics, Division of Pediatric Critical Care, David Geffen School of Medicine at UCLA, Torrance, CA, USA. kevin.haug@ucdmc.ucdavis.edu
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Haug
authors.forename: Barry G
authors.initials: BG
authors.lastname: Baylen
authors.forename: Richard B
authors.initials: RB
authors.lastname: Mink
mesh_terms: D000293:Adolescent; D003131:Combined Modality Therapy; D003655:Decerebrate State / Q000209:etiology; D004298:Dopamine / Q000009:adverse effects / Q000627:therapeutic use; D017809:Fatal Outcome; D005440:Fluid Therapy / Q000009:adverse effects; D006261:Headache / Q000209:etiology; D006323:Heart Arrest / Q000209:etiology; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications*; D008297:Male; D008353:Mannitol / Q000627:therapeutic use; D017682:Myocardial Stunning / Q000209:etiology; D011651:Pulmonary Artery; D012422:Rupture, Spontaneous; D012640:Seizures / Q000209:etiology; D013203:Staphylococcal Infections / Q000150:complications; D013345:Subarachnoid Hemorrhage / Q000209:etiology; D019210:Troponin I / Q000097:blood; D014696:Ventriculostomy
chemical_list: D019210:Troponin I; D008353:Mannitol; D004298:Dopamine