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Images in Paediatrics
Diffuse subarachnoid haemorrhage with obstructive hydrocephalus in a 4-year-old girl
Hemorragia subaracnoidea difusa con hidrocefalia obstructiva en niña de 4 años
Ana Gutiérrez-Véleza,
Corresponding author
ana.gutierrez@salud.madrid.org

Corresponding author.
, Clara Ferrero García-Loygorria, Mariano Del Valle Diéguezb, Juan Vicente Darriba Allesc
a Sección de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
b Sección de Radiología Vascular e Intervencionista, Servicio de Radiodiagnóstico, Hospital General Universitario Gregorio Marañón, Madrid, Spain
c Servicio de Neurocirugía, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A girl aged 4 years was brought to the emergency department for assessment intense headache and vomiting the onset of which was followed by an episode of loss of consciousness and hypotonia that lasted 5&#8239;min&#46; The patient presented with pallor and a Glasgow Coma Scale of 14 points&#46; The mother reported that the patient had suffered from chronic headache for one year&#46; The findings of a CT scan &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41; prompted placement of an external ventricular drain&#46; The angiogram &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B and C&#41; revealed the presence of an aneurysm in the basilar artery&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Parent artery sacrifice and stent-assisted reconstruction were ruled out as treatment options like were ruled out on account of the age of the patient and anatomical considerations&#46; Flow reversal in the parent artery was considered the optimal approach&#44; as the balloon occlusion test of the single left vertebral &#40;with extreme hypoplasia of the right vertebral artery&#41;&#44; was performed under neurophysiological monitoring and achieved an adequate deviation of basilar flow&#46; Thus&#44; the aneurysm was managed through endovascular occlusion of the left vertebral artery past the posterior cerebellar artery&#46; An MRI scan was performed after the endovascular intervention &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#8211;G&#41;&#46; The patient was discharged at 34 days free of neurologic sequelae&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Cerebral aneurysms are infrequent in children&#44; with an estimated incidence of 0&#46;5&#37;&#8211;4&#46;6&#37;&#46; The most common clinical manifestation is headache&#44; followed by syncope and seizures&#46; Partially thrombosed giant aneurysms are a particular subset of aneurysms that should be considered a separate clinical and pathological entity&#46; Due to its histological characteristics and the tendency to exert a mass effect&#44; the optimal treatment is the sacrifice of the parent vessel with open or endovascular surgery&#46; In this article&#44; we present the second paediatric case managed with this approach in our hospital&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">This research did not receive any external funding&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; The CT scan showed subarachnoid haemorrhage and obstructive hydrocephalus&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Cerebral angiogram&#46; Left vertebral artery series&#58; &#40;B&#41; lateral view and &#40;C&#41; anteroposterior view&#46; Giant fusiform aneurysm in the two lower thirds of the basilar artery&#46; Treatment options like parent artery sacrifice or stent-assisted reconstruction were ruled out on account of the age of the patient and anatomical considerations&#46;</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">T1-weighted and FLAIR &#40;fluid-attenuated inversion recovery&#41; MRI images&#58; &#40;D&#41; and &#40;E&#41; immediate postoperative period&#44; and &#40;F&#41; and &#40;G&#41; 6 months after surgery&#46; The images show a progressive reduction of the aneurysmal pouch and partial resolution of mass effect and obstructive hydrocephalus&#46;</p>"
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ISSN: 23412879
Original language: English
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