I had a similar case Tucson 5 days ago. 19mo previously healthy male presented with a day of low-grade fever, lethargy and a few hours of coffee-ground emesis. No respi symptoms. Surg work-up was neg. Other initial work- up results were nonspecific w transaminitis, AKI and metabolic acidosis. Then he started seizing. Head CT was negative but had very high opening pressure on LP (52 cmH2O). Also w signif CSF proteinuria (> 600mg/dl) but neg cells. Viral respi PCR was (+) for parainfluenza. Then he developed bradycardia responsive to fluids and stimulation. Later, echo showed dilated cardiomyopathy w L ventricular enlargement. Prior Xrays did not show cardiomegaly. He was transferred for ECMO the same day but did not make it.
Ana Swafford, MD
Tucson Medical Center
Sent from my iPhone
> On Aug 9, 2018, at 12:59 AM, Lisa Amir <[log in to unmask]> wrote:
> Curious for the list's experience…
> We have had 2 children in the last 10 days with intracranial bleeds who had arrhythmias or myocardial dysfunction
> The first was a 5 year old who presented with SE who developed bradycardia and then asystole. His POCUS-echo demonstrated good cardiac function after resuscitation. The combination of the two suggested severe ICP and his head CT demonstrated a large SAH due to a bleeding (previously undiagnosed) AVM. He died the next day from uncontrollable ICP and v-fib; he developed severely reduced cardiac function about 12 hours after admission
> The second was a 7 day old who presented with stridor. An extensive workup was negative and then he developed bradycardia with poor perfusion; POCUS-echo demonstrated irregular heart rate but good contractility. POCUS of his head demonstrated blood in the ventricles. He was eventually diagnosed with hemophilia and did better after ventriculostome. I don't have followup as he was transferred to another hospital which manages hemophilia
> I've had patients with bradycardia due to elevated ICP but the primary diagnosis was always clear (head trauma, VP shunt malfunction). I did a quick literature search and this is reported in adults as a known but uncommon complication. Didn't find any literature on pediatrics.
> Lisa Amir, MD, MPH
> Deputy Chair
> Department of Emergency Medicine
> Schneider Children's Medical Center of Israel
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