ABSTRACT
The purpose of this study was to determine the prognosis of children and adults in whom decompressive craniectomy (DC) was used as a rescue treatment to lower refractory high intracranial pressures if maximal conservative therapies failed.Data of DC patients were retrospectively reviewed. Three-month and 1-year outcomes were evaluated (modified Rankin Score). Twenty-one patients were studied, 8 children and 13 adults. Eleven suffered from traumatic brain swelling, in 10 the primary pathological condition was intracranial hemorrhage, arteriovenous malformation bleeding or subarachnoid hemorrhage. All 13 survivors (62%) had a favorable outcome after 1 year (mRS≤3), 8 (38%) lacked any disabilities at all. Therefore, decompressive craniectomy offers a chance for a favorable outcome in uncontrollable ICP.
Subject(s)
Decompressive Craniectomy/methods , Intracranial Hypertension/surgery , Adolescent , Adult , Age Factors , Blood Pressure/physiology , Brain Edema/etiology , Brain Edema/surgery , Child , Female , Humans , Intracranial Hypertension/complications , Intracranial Pressure/physiology , Male , Middle Aged , Retrospective Studies , Treatment OutcomeABSTRACT
A 6-month-old male infant with an unremarkable past medical history was admitted to the emergency department in an epileptic state. The seizures were resistant to treatment with conventional drugs. The child was sedated, intubated and admitted to the intensive care department. Despite extensive investigations no underlying disease was found. The seizures persisted and the child was repeatedly admitted to the hospital. Four months after the first presentation, ventricular fibrillation occurred from which the child was successfully resuscitated. His stomach appeared to contain a disinfectant and a severe ethanol-intoxication was found, leading to the diagnosis "Munchausen syndrome by proxy". The incidence of this syndrome is underestimated. Recognition of this potentially fatal phenomenon is often difficult, resulting in a delay in diagnosis. Paediatricians and general practitioners should be aware of this syndrome in children presenting with an unusual disease or an unusual medical history reported by the parents or care providers.
