Treatment of Increased Intracranial Pressure and Vasospasm after Subarachnoid Hemorrhage in a 9-Year-Old Child—A Case ReportFunding None.
We report a 9-year-old patient who suffered severe subarachnoid hemorrhage due to ruptured dissecting aneurysm of the left parieto-occipital artery. After endovascular occlusion of the aneurysm, increased intracranial pressure refractory to noninvasive therapy required secondary decompressive hemicraniectomy. Critical vasospasm and delayed neurological deterioration were treated by oral nimodipine and successful endovascular rescue therapy consisting of intra-arterial balloon dilatation.
Availability of Data and Material
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
S.-H.M. wrote the manuscript. C.T., S.M., E.M., R.R., and J.B. revised the manuscript. All authors contributed substantially to this work and all of them revised and agreed to the final version of the manuscript with full access to all data.
Consent for Publication
Written consent for publication of this report was obtained from the patient's parents.
Received: 08 October 2020
Accepted: 20 November 2020
04 February 2021 (online)
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Sorteberg A, Dahlberg D. Intracranial non-traumatic aneurysms in children and adolescents. Curr Pediatr Rev 2013; 9 (04) 343-352
- 2 Hetts SW, Narvid J, Sanai N. et al. Intracranial aneurysms in childhood: 27-year single-institution experience. AJNR Am J Neuroradiol 2009; 30 (07) 1315-1324
- 3 Krings T, Geibprasert S, terBrugge KG. Pathomechanisms and treatment of pediatric aneurysms. Childs Nerv Syst 2010; 26 (10) 1309-1318
- 4 Kim ST, Brinjikji W, Lanzino G, Kallmes DF. Neurovascular manifestations of connective-tissue diseases: a review. Interv Neuroradiol 2016; 22 (06) 624-637
- 5 Lasjaunias P, terBrugge KG, Berenstein A. Intracranial aneurysms in children. Surgical Neuroangiography Part 3: Clinical and Interventional Aspects in Children. Berlin, Heidelberg: Springer; 2006
- 6 Vaid VK, Kumar R, Kalra SK, Mahapatra AK, Jain VK. Pediatric intracranial aneurysms: an institutional experience. Pediatr Neurosurg 2008; 44 (04) 296-301
- 7 Krishna H, Wani AA, Behari S, Banerji D, Chhabra DK, Jain VK. Intracranial aneurysms in patients 18 years of age or under, are they different from aneurysms in adult population?. Acta Neurochir (Wien) 2005; 147 (05) 469-476 , discussion 476
- 8 Sanai N, Quinones-Hinojosa A, Gupta NM. et al. Pediatric intracranial aneurysms: durability of treatment following microsurgical and endovascular management. J Neurosurg 2006; 104 (2, Suppl:): 82-89
- 9 Jabbarli R, Pierscianek D, Rölz R. et al. Endovascular treatment of cerebral vasospasm after subarachnoid hemorrhage: more is more. Neurology 2019; 93 (05) e458-e466
- 10 Heffren J, McIntosh AM, Reiter PD. Nimodipine for the prevention of cerebral vasospasm after subarachnoid hemorrhage in 12 children. Pediatr Neurol 2015; 52 (03) 356-360
- 11 Li K, Barras CD, Chandra RV. et al. A review of the management of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. World Neurosurg 2019; 126: 513-527
- 12 Liang J, Bao Y, Zhang H. et al. The clinical features and treatment of pediatric intracranial aneurysm. Childs Nerv Syst 2009; 25 (03) 317-324
- 13 Sharma BS, Sinha S, Mehta VS, Suri A, Gupta A, Mahapatra AK. Pediatric intracranial aneurysms-clinical characteristics and outcome of surgical treatment. Childs Nerv Syst 2007; 23 (03) 327-333
- 14 Hetts SW, English JD, Dowd CF, Higashida RT, Scanlon JT, Halbach VV. Pediatric intracranial aneurysms: new and enlarging aneurysms after index aneurysm treatment or observation. AJNR Am J Neuroradiol 2011; 32 (11) 2017-2022
- 15 Pendharkar AV, Guzman R, Dodd R, Cornfield D, Edwards MSB. Successful treatment of severe cerebral vasospasm following hemorrhage of an arteriovenous malformation. Case report. J Neurosurg Pediatr 2009; 4 (03) 266-269