Bilateral decompressive craniectomy for refractory intracranial hypertension in a child with severe ITP-related intracerebral haemorrhage.
We report a 13-month-old infant who developed acutely elevated intracranial pressure (ICP) as a result of a spontaneous intracerebral haemorrhage (ICH), secondary to idiopathic thrombocytopenic purpura (ITP). Her ICP remained severely elevated despite aggressive medical measures, with persistent obtundation, right hemiparesis and a dilated left pupil. Bilateral decompressive craniectomies (DCs) were performed, which resulted in a rapid decline in ICP. Ultimately, the patient regained consciousness and went on to complete neurological recovery. Tragically, she died of non-neurological, ITP-related complications 9 months later. In our review, we identified no other instances of bilateral DCs reported in the management of an infant with ITP and/or an ICH. We addressed three central questions: (1) Is there any value of DCs in children, and especially in infants, with elevated ICP? (2) Is there any value of DCs in the setting of non-traumatic ICH? And (3) is there any rationale for the use of bilateral versus unilateral DCs?
Ranger
Adrianna
A
Department of Pediatric Neurosurgery, London Health Sciences Center, London, ON N6A 5W9, Canada. aranger@uwo.ca
Szymczak
Artur
A
Fraser
Douglas
D
Salvadori
Marina
M
Jardine
Lawrence
L
D000208:Acute Disease; D000741:Anemia, Aplastic / Q000150:complications; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D056424:Decompressive Craniectomy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007223:Infant; D019586:Intracranial Hypertension / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications*; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed