Artikel
Severe non-traumatic transtentorial brain herniation due to untreated communicating hydrocephalus in a young child
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Autoren
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Sevgi Sarikaya-Seiwert
- Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf, Deutschland
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Bernd Turowski
- Institut für Radiologie, Heinrich-Heine-Universität, Düsseldorf, Deutschland
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Thomas Höhn
- Klinik für Allgemeine Pädiatrie, Heinrich-Heine-Universität, Düsseldorf, Deutschland
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Hans-Jakob Steiger
- Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf, Deutschland
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Daniel Hänggi
- Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf, Deutschland
| Veröffentlicht: | 16. September 2010 |
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Gliederung
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Objective: Transtentorial herniation is known result from severe head injury, intracerebral hemorrhage, cerebral infarction or brain tumors in adults. Other etiologies have not been described in the English-language literature, and in particular in children. We report a unique case of a spontaneous and asymmetric transtentorial brain herniation due to communicating hydrocephalus.
Methods: A 5-year old girl presented to the pediatric emergency room with acute right-sided oculomotor nerve palsy, a left-sided facial paresis and a severe right hemiparesis. The child had suffered from recurrent headache for two weeks. The ophthalmological examination ruled out papilledema. The head circumference of the child was normal. At the age of 14 weeks the child had suffered from an acute and unclear life-threatening event with severe asphyxia. This event resulted in a cardiopulmonary resuscitation. A magnet resonance imaging (MRI) performed one week after this event showed diffuse parenchymatous bleeding in both occipital lobes. During the further development, retardation regarding verbal and psychomotor skills was diagnosed. The acute event during early childhood was assumed to be the cause for the retardation. The MRI showed an asymmetric transtentorial herniation of major parts of the temporal lobe due to unrecognized communicating hydrocephalus. The symptoms associated with herniation were treated by a programmable ventriculo-peritoneal shunt.
Results: After successful surgery, the patient recovered completely. The postoperative course was uneventful. A follow-up examination after six months no longer showed developmental retardation regarding verbal and psychomotor skills. The girl was able to walk without assistance and there were no limitations of speech. The six month follow-up MRI sequences showed a decrease in the width of the ventricle. The transtentorial brain-herniation was regressing.
Conclusions: Untreated chronic communicating hydrocephalus in children can lead to spontaneous asymmetric transtentorial brain herniation with severe neurological symptoms.
