• Pediatric neurosurgery · Jan 2009

    Case Reports

    Bilateral decompressive craniectomy for refractory intracranial hypertension in a child with severe ITP-related intracerebral haemorrhage.

    • Adrianna Ranger, Artur Szymczak, Douglas Fraser, Marina Salvadori, and Lawrence Jardine.
    • Department of Pediatric Neurosurgery, London Health Sciences Center, London, ON N6A 5W9, Canada. aranger@uwo.ca
    • Pediatr Neurosurg. 2009 Jan 1;45(5):390-5.

    AbstractWe 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.

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