1. Bilateral decompressive craniectomy for refractory intracranial hypertension in a child with severe ITP-related intracerebral haemorrhage.
- Author
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Ranger A, Szymczak A, Fraser D, Salvadori M, and Jardine L
- Subjects
- Acute Disease, Anemia, Aplastic complications, Cerebral Hemorrhage diagnostic imaging, Fatal Outcome, Female, Humans, Infant, Intracranial Hypertension diagnostic imaging, Severity of Illness Index, Tomography, X-Ray Computed, Cerebral Hemorrhage etiology, Cerebral Hemorrhage surgery, Decompressive Craniectomy, Intracranial Hypertension etiology, Intracranial Hypertension surgery, Purpura, Thrombocytopenic, Idiopathic complications
- Abstract
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?, (Copyright 2009 S. Karger AG, Basel.)
- Published
- 2009
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