Elevated intracranial pressure requiring decompressive craniectomy in a child with progressive primary angiitis of the central nervous system: a case report

• Published in: Journal of medical case reports Vol. 15; no. 1; pp. 418 - 6
• Main Authors: Al-Mansour, Lama S, AlRasheed, Abdulrahman A, AlEnezi, Khaled R, AlAli, Hamza M
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 06-08-2021; BioMed Central; BMC
• Subjects: Abdomen; Anesthesia; Blood pressure; Case Report; Case reports; Central nervous system; Child; Child, Preschool; Children; Coma; Craniectomy; Decompressive Craniectomy; Disease; Edema; Epilepsy; Female; Health aspects; Heart rate; Humans; Immunology; Inflammation; Injuries; Intracranial Hypertension - surgery; Intracranial Pressure; Laboratories; Levetiracetam; Magnetic resonance imaging; Medical imaging; Nervous system; Nervous system diseases; Pediatric emergencies; Pediatrics; Primary angiitis; Traumatic brain injury; Tumor necrosis factor-TNF; Vasculitis; Vasculitis, Central Nervous System; Primary angiitis; Case report; Intracranial pressure; Craniectomy; Central nervous system
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-021-03005-y

Elevated intracranial pressure is a potentially catastrophic complication of neurologic injury in children. Successful management of elevated intracranial pressure requires prompt recognition and therapy directed at both reducing intracranial pressure and reversing its underlying cause. A rare condition that causes elevated intracranial pressure is childhood primary angiitis of the central nervous system, which is a rare inflammatory central nervous system disease that poses diagnostic and therapeutic challenges. To our knowledge, this is the first reported case of angiography-positive progressive childhood primary angiitis of the central nervous system requiring decompressive hemicraniectomy for refractory elevated intracranial pressure in children.
We report the case of a 5-year-old Saudi girl who presented to the pediatric emergency department with fever and new-onset status epilepticus. She had elevated inflammatory markers with radiological and histopathological evidence of angiography-positive progressive childhood primary angiitis of the central nervous system, complicated by elevated intracranial pressure. Despite medical management for both childhood primary angiitis of the central nervous system and elevated intracranial pressure, her neurological status continued to deteriorate and the elevated intracranial pressure became refractory. She developed right uncal, right subfalcine, and tonsillar herniation requiring decompressive hemicraniectomy with a favorable neurological outcome.
Decompressive craniectomy might be considered in cases of angiography-positive progressive childhood primary angiitis of the central nervous system with elevated intracranial pressure refractory to medication. A multidisciplinary approach for the decision of decompressive craniectomy is advised to ensure patient safety and avoid possible morbidities and mortality.