Decompressive Hemicraniectomy for Acute Disseminated Encephalomyelitis: Case Report

Author:

Refai Daniel1,Lee Max C.2,Goldenberg Fernando D.3,Frank Jeffrey I.3

Affiliation:

1. Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri

2. Department of Neurosurgery, Stanford University Medical Center, Stanford, California

3. Department of Neurology, University of Chicago, Chicago, Illinois

Abstract

Abstract OBJECTIVE AND IMPORTANCE: Acute disseminated encephalomyelitis (ADEM) varies widely in symptoms and severity. Some cases are associated with massive life-threatening cerebral edema refractory to conventional medical management. CLINICAL PRESENTATION: A 51-year-old woman with ADEM who developed severe brain swelling and herniation despite aggressive medical management is described. INTERVENTION: A decompressive hemicraniectomy and durotomy led to rapid improvement and an excellent outcome. CONCLUSION: 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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Clinical Neurology,Surgery

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3. Treatment of right hemispheric cerebral infarction by hemicraniectomy;Delashaw;Stroke,1990

4. Acute brain infarctions with high intracranial pressure: Surgical indications;Greenwood;Johns Hopkins Med J,1968

5. Acute disseminated encephalomyelitis in adults: A reappraisal of clinical, CSF, EEG, and MRI findings;Hollinger;J Neurology,2002

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