Symptomatic Cerebral Vasospasm Following Resection of a Medulloblastoma in a Child
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PRACTICAL PEARL
Symptomatic Cerebral Vasospasm Following Resection of a Medulloblastoma in a Child Vamshi K. Rao • Abilash Haridas • Thanh T. Nguyen • Rishi Lulla Mark S. Wainwright • Joshua L. Goldstein
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Published online: 22 August 2012 Ó Springer Science+Business Media, LLC 2012
Abstract Background Vasospasm may occur following intracranial tumor resection but is uncommon following resection of tumors in the posterior fossa. Methods Case report. Results Here, we report an unusual pediatric case of symptomatic cerebral vasospasm following resection of a posterior fossa medulloblastoma in a 10-year-old child. CT angiogram and serial Transcranial Doppler (TCD) studies confirmed the presence of vasospasm and response to hemodynamic augmentation therapy, resulting in favorable outcome. Conclusion This case illustrates an unusual complication of posterior fossa tumor resection, and the potential utility of TCD studies in the detection and management of vasospasm in pediatric neurocritical care.
V. K. Rao T. T. Nguyen M. S. Wainwright J. L. Goldstein (&) Division of Neurology, Department of Pediatrics, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, No. 51, 225 E. Chicago Ave., Chicago, IL 60611, USA e-mail: [email protected] A. Haridas Department of Neurosurgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA R. Lulla Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Keywords Vasospasm Medulloblastoma Transcranial doppler Pediatric
Introduction Vasospasm may occur following subarachnoid hemorrhage, traumatic brain injury (TBI) without SAH, meningitis, preeclampsia, and unruptured aneurysms [1–5]. In contrast, cerebral vasospasm following intracranial tumor resection is rare. Most of the described cases have occurred following resection of meningiomas and pituitary adenomas. It has also been reported after resection with respect to schwannomas, acoustic neuromas, astrocytoma, brain metastasis, and neuroectodermal tumor [6–15]. Vasospasm following tumor resection in children is rare. The process may be under recognized and may be one of the causes of neurological decline in the delayed post-operative period. Cases in the adult literature that were recognized early recovered back to post-operative baseline with aggressive therapy, including medical management (hemodynamic augmentation) and/or endovascular interventions [16, 17]. Here, we report a case of symptomatic cerebral vasospasm following resection of a medulloblastoma in a 10-year-old child. There are only two previous reports of cerebral vasospasm in children, one with a poor outcome [11, 15]. In the present case, neuroimaging, serial Transcranial Doppler (TCD) and hemodynamic augmentation [24] were used to identify the presence of vasospasm and to
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