Decompressive Hemicraniectomy for Acute Disseminated Encephalomyelitis: Case Report

Abstract

This case report reinforces the place of this procedure in the armamentarium of treatment options for patients with medically refractory brain swelling and elevated intracranial pressure caused by ADEM. The potential for an increase in the incidence of ADEM with more frequent smallpox vaccinations emphasizes the significance of redefining the full range of management options for this treatable disease.

Predictors of outcome in acute encephalitis

“…There have been few previous studies examining the utility of ICP monitoring and management of cerebral edema with hyperosmolar therapy and decompressive surgery in patients with meningoencephalitis. [12][13][14][15][16][17][18] Our results suggest that clinicians must maintain vigilance for any change in pupil reactivity, development of focal neurologic deficits, and changes in level of consciousness. Given evidence that herniation may be reversible with aggressive management, use of hyperosmolar therapy should be initiated emergently, and neurosurgery should be considered if there are signs of mass effect.…”

Life-saving decompressive craniectomy for acute disseminated encephalomyelitis in a child: a case report

“…The only reported cases concern four adult patients and indicate that decompression in adult patients with ADEM is effective and associated with a favorable outcome. The four patients have mild residual neurological deficits soon after craniectomy [1,17,19,23]. Our patient is the first reported child with ADEM who sustained a life-saving craniectomy after monitoring of the intracranial pressure (Fig.…”

“…Decompressive craniectomy in ADEM is reported rarely in medical literature [1,17,19,23]. The only reported cases concern four adult patients and indicate that decompression in adult patients with ADEM is effective and associated with a favorable outcome.…”

Decompressive Craniectomy for Acute Disseminated Encephalomyelitis

“…Previous reports in which a decompressive craniectomy has been performed for ADEM [8][9][10] or tumefactive demyelination [4,11] are limited. However, these reports indicate that decompression in patients with ADEM is suggestive of a favourable outcome with only mild residual neurological deficits at 3 months [8,9]. In our case, the rapid nature of decompression (within 10 h of initial presentation to hospital and within 4 h of onset of a rapid decrease in her Glasgow Coma Score) led to minimal neurological sequelae 3 months after surgery.…”