Therapeutic hypothermia for treatment of intractable intracranial hypertension after liver transplantation.
A comatose 23-year-old woman with acute liver failure due to an overdose of acetaminophen had indications of intracranial hypertension and underwent liver transplantation. Her level of arousal did not improve, and on postoperative day 1, clinical signs of cerebral herniation became apparent. An intracranial pressure monitor was placed, and intracranial hypertension was documented. Elevations in intracranial pressure persisted despite maximal osmotherapy, and therapeutic hypothermia was started. Normalization of intracranial pressure was rapid. Findings on neurological examination improved and the patient was discharged from the hospital with no neurological impairment.
Department of Trauma and Surgical Critical Care, Hospital of the University of Pennsylvania, Philadelphia, USA.
Daniel N
DN
Holena
Nikolai S
NS
Tolstoy
Angela M
AM
Mills
Adam D
AD
Fox
Joshua M
JM
Levine
D000082:Acetaminophen / Q000009:adverse effects*; D062787:Drug Overdose; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D019586:Intracranial Hypertension / Q000209:etiology / Q000628:therapy*; D007427:Intracranial Pressure; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000150:complications / Q000601:surgery; D016031:Liver Transplantation; D016896:Treatment Outcome; D055815:Young Adult
D000082:Acetaminophen