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Abstract Details

Acute fulminant cerebral edema: a profile of 5 pediatric cases from a tertiary care center.
Neuro Trauma, Critical Care, and Sports Neurology
P16 - Poster Session 16 (5:30 PM-6:30 PM)
13-016
Fulminant cerebral edema is a poorly understood serious neurologic condition with a high fatality rate. The objective of this case series is to compare the presenting features, time course, underlying etiology, and management of 5 pediatric patients presenting with fulminant cerebral edema.
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We review a case series of five pediatric patients who presented with fulminant cerebral edema at Children’s Hospital of Philadelphia between 2018 and 2019. Patients were included if they presented with acute encephalopathy defined as rapid deterioration in mental status, and had neuroimaging evidence of fulminant cerebral edema.
Five patients, two females and three males between 2 to 7 years old, were included in this case series. All patients had prodromal symptoms. Two patients were positive for influenza, and one patient had neuropathology consistent with acute hemorrhagic leukoencephalitis on autopsy. In two cases, no cause was identified. Treatments included broad spectrum antibiotics, hyperosmolar agents, IV steroids, management of seizures with anti-convulsive agents, and decompressive craniectomy.  Four patients died, and one patient had a good outcome.
Acute encephalopathy complicated by fulminant cerebral edema is a rapidly evolving, and often fatal neurologic condition. While flu was the most common etiology, more than one etiology was present in the case series consistent with previous assertions that fulminant cerebral edema is a common pathophysiologic endpoint to multiple disease processes.  Early identification with neuroimaging and intervention may improve outcomes, and steroids may have provided benefit in the patient who survived. However, the rapid course of the disease poses continued challenges.
Authors/Disclosures
Carlyn Patterson Gentile, MD
PRESENTER 		The institution of Dr. Patterson Gentile has received research support from NIH/NINDS. The institution of Dr. Patterson Gentile has received research support from Children's Hospital of Philadelphia. Dr. Patterson Gentile has received personal compensation in the range of $500-$4,999 for serving as a Faculty, Annual Scientific Meeting, Scottsdale Meeting with American Headache Society. Dr. Patterson Gentile has received personal compensation in the range of $5,000-$9,999 for serving as a Early Career Awardee with American Headache Society. Dr. Patterson Gentile has received personal compensation in the range of $0-$499 for serving as a Research Prize Awardee and travel expense coverage with NIH Pain Consortium. Dr. Patterson Gentile has received personal compensation in the range of $500-$4,999 for serving as a Faculty, Speaker with Headache Cooperative of New England. Dr. Patterson Gentile has received personal compensation in the range of $500-$4,999 for serving as a Speaker, Awardee with Â鶹´«Ã½Ó³»­.
Duriel I. Hardy, MD (Dell Children's Specialty Pavillian) Dr. Hardy has nothing to disclose.
Sonika Agarwal, MD, FÂ鶹´«Ã½Ó³»­ Dr. Agarwal has nothing to disclose.