Acute cerebellar edema after traumatic brain injury in a child. a case report

Abstract

Traumatic brain injuries (TBI) are a major cause of morbidity and mortality in children. Malignant cerebral edema is described to occur more often in children than in adults. Its infratentorial analogous, a malignant cerebellar edema, has not been reported yet. A 10-year-old boy fell from a height of 3 m where he sustained a TBI. Approximately 36 h after trauma, a significant drop in Glasgow Coma Scale (GCS) occurred accompanied by bilateral fixed and dilated pupils. A computed tomography (CT) scan revealed an underlying acute cerebellar edema without evidence of a sinus vein thrombosis or cerebellar contusions. Immediate suboccipital decompressive surgery and insertion of an external ventricular drain (EVD) were performed. Early postoperative CT imaging showed increasing, space-occupying frontal contusions and perilesional edema, which is why an additional bifrontal craniectomy was performed. A posttraumatic hydrocephalus occurring on the 27th day after trauma was treated with a ventricular-peritoneal shunt. On follow-up, 6 months after trauma, he showed a GCS of 15 with no evident neurological findings. This case report is the first to describe and discuss an acute cerebellar edema occurring after TBI. Its acute complications of brainstem compression and obstructive hydrocephalus are effectively treated by immediate suboccipital decompression and EVD insertion.

Keywords: Bifrontal craniectomy; Cerebellar edema; Pediatric neurosurgery; Posttraumatic hydrocephalus; Traumatic brain injury.