Horak V Jane, Patel Nirali, Abdelmageed Sunny, Scoville Jonathan, LoPresti Melissa A, Lam Sandi
1Division of Pediatric Neurosurgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois.
2Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois.
J Neurosurg Case Lessons. 2024 Apr 1;7(14). doi: 10.3171/CASE23765.
Cerebral vasospasm is commonly associated with adult aneurysmal subarachnoid hemorrhage but can develop in children. The standard vasospasm treatment includes induced hypertension, avoidance of hypovolemia, systemic use of the calcium channel blocker (CCB) nimodipine, and cerebral angiography for intraarterial therapy. Emerging treatments in adults, such as intraventricular CCB administration, have not been investigated in children. This study demonstrates the successful use of an intraventricular CCB in a pediatric patient with refractory vasospasm secondary to meningitis.
A 12-year-old female presented with Streptococcus pneumoniae meningitis and ventriculitis with refractory symptomatic cerebral vasospasm. She received a 5-day course of intrathecal nicardipine through an existing external ventricular drain. Her clinical status, transcranial Doppler studies, and radiography improved. Treatment was well tolerated.
Pediatric vasospasm is uncommon and potentially devastating. The management of vasospasm in adults occurs frequently. Principles of this management are adapted to pediatric care given the rarity of vasospasm in children. The use of intraventricular nicardipine has been reported in the care of adults with level 3 evidence. It has not been adequately reported in children with refractory vasospasm. Here, the first use of intraventricular nicardipine in treating pediatric cerebral vasospasm in the setting of meningitis is described and highlighted.
脑血管痉挛通常与成人动脉瘤性蛛网膜下腔出血相关，但也可能在儿童中发生。标准的血管痉挛治疗包括诱导高血压、避免血容量过低、全身使用钙通道阻滞剂（CCB）尼莫地平以及进行脑血管造影以实施动脉内治疗。成人中出现的一些新治疗方法，如脑室内给予CCB，尚未在儿童中进行研究。本研究展示了在一名因脑膜炎继发难治性血管痉挛的儿科患者中成功使用脑室内CCB的情况。
一名12岁女性因肺炎链球菌性脑膜炎和脑室炎伴难治性症状性脑血管痉挛就诊。她通过现有的外部脑室引流管接受了为期5天的鞘内给予尼卡地平治疗。她的临床状况、经颅多普勒研究结果及影像学表现均有改善。治疗耐受性良好。
儿童血管痉挛并不常见且可能具有毁灭性。成人血管痉挛的管理较为常见。鉴于儿童血管痉挛罕见，这种管理原则适用于儿科护理。在成人护理中已有使用脑室内尼卡地平的报道，证据等级为3级。在难治性血管痉挛儿童中尚未有充分报道。在此，描述并强调了首次在脑膜炎背景下使用脑室内尼卡地平治疗儿童脑血管痉挛的情况。
