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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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