Craniectomy for acute disseminated encephalomyelitis

Bourke, David; Woon, Kelvin

doi:10.1136/practneurol-2020-002705

Cited by 5 publications

(3 citation statements)

References 9 publications

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“…70 Nonetheless, a decision to proceed with surgery must balance each patient's goals of care and prognosis, given their age and comorbidities. Although hemicraniectomy has been preferred for infectious encephalitis affecting the temporal lobes, 71 both decompressive craniectomy (with or without concurrent lobectomy) and temporal lobectomy have been reported in HSVE. Our review and a prior retrospective review 70 suggest that the latter approach can be efficacious and may be particularly suitable when there is a focal lesion in the temporal lobe.…”

Section: Discussionmentioning

confidence: 99%

Surgical Management in Herpes Simplex Encephalitis: Illustrative Case Report and Systematic Review of the Literature

et al. 2023

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BACKGROUND:Herpes simplex virus (HSV) is a common cause of viral encephalitis and can result in refractory seizures. Although HSV encephalitis (HSVE) is treated primarily with acyclovir, surgery can play a role in medically intractable cases.OBJECTIVE:To systematically review cases describing surgery for the treatment of severe HSVE. We also present an illustrative case of anterior temporal lobectomy (ATL) for refractory status epilepticus in a patient with unilateral HSVE. This case demonstrates one clinical context in which surgery can be a useful adjunct.METHODS:We performed a systematic review using PubMed and Google Scholar, including case reports and series describing surgical interventions for HSVE. Clinical data were extracted from 54 publications that incorporated 67 patient cases.RESULTS:Surgical decompression occurred at a wide range of times after the onset of illness, although most patients were operated on 4 or more days after HSVE symptoms began. Numerous reports indicated that decompressive craniectomy, temporal lobectomy, and hematoma removal could treat intractably elevated intracranial pressure because of HSVE with favorable long-term outcomes. We describe an additional case in which a 52-year-old woman with HSVE developed refractory right temporal lobe seizures. After ATL, the seizures resolved with significant clinical improvement.CONCLUSION:Surgical treatment can be a useful adjunct for treatment of HSVE. There is substantial variability in the timing of surgical decompression in patients with HSVE, which can be necessary up to approximately 3 weeks after illness onset. ATL should be considered for refractory status epilepticus in HSVE with a unilateral seizure focus.

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Section: Discussionmentioning

confidence: 99%

Surgical Management in Herpes Simplex Encephalitis: Illustrative Case Report and Systematic Review of the Literature

et al. 2023

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“…Although there are no strong data to support their use in this patient population, standard treatments of elevated intracranial pressure are appropriate, including sedation and osmotherapy 38,101,102 . In refractory cases, decompressive craniectomy may be considered ( case 9-1 ) 8,103-108 …”

Section: Complications Of Tumefactive and Aggressive Demyelinating Di...mentioning

confidence: 99%

Emergent Management of Central Nervous System Demyelinating Disorders

Czeisler

2024

CONTINUUM: Lifelong Learning in Neurology

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OBJECTIVE This article reviews the various conditions that can present with acute and severe central nervous system demyelination, the broad differential diagnosis of these conditions, the most appropriate diagnostic workup, and the acute treatment regimens to be administered to help achieve the best possible patient outcomes. LATEST DEVELOPMENTS The discovery of anti–aquaporin 4 (AQP4) antibodies and anti–myelin oligodendrocyte glycoprotein (MOG) antibodies in the past two decades has revolutionized our understanding of acute demyelinating disorders, their evaluation, and their management. ESSENTIAL POINTS Demyelinating disorders comprise a large category of neurologic disorders seen by practicing neurologists. In the majority of cases, patients with these conditions do not require care in an intensive care unit. However, certain disorders may cause severe demyelination that necessitates intensive care unit admission because of numerous simultaneous multifocal lesions, tumefactive lesions, or lesions in certain brain locations that lead to acute severe neurologic dysfunction. Intensive care may be necessary for the management and prevention of complications for patients who have severely altered mental status, rapidly progressive neurologic worsening, elevated intracranial pressure, severe cerebral edema, status epilepticus, or respiratory failure.

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“…Decompressive hemicraniectomy may be life-saving when cerebral oedema is refractory to medical treatment. 24…”

Section: Acute Disseminated Encephalomyelitismentioning

confidence: 99%

Rhomboencephalitis

2020

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Rhomboencephalitis—inflammation of the brainstem and cerebellum—has myriad clinical presentations including encephalopathy, cranial neuropathies, long tract signs and cerebellar dysfunction and is associated with significant morbidity and mortality. There are a variety of potential underlying causes that respond variably to treatment, including infections, parainfective syndromes, inflammatory disorders including autoimmune encephalitis and paraneoplastic syndromes. Here, we review its clinical presentation and outline a practical approach to its investigation, aiming to facilitate prompt diagnosis and confirmation of the underlying cause, to start appropriate management early and optimise the clinical outcome.

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Craniectomy for acute disseminated encephalomyelitis

Cited by 5 publications

References 9 publications

Surgical Management in Herpes Simplex Encephalitis: Illustrative Case Report and Systematic Review of the Literature

Surgical Management in Herpes Simplex Encephalitis: Illustrative Case Report and Systematic Review of the Literature

Emergent Management of Central Nervous System Demyelinating Disorders

Rhomboencephalitis

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