Hyperbaric Oxygen Therapy proves to be a successful treatment option for severe brain edema in pediatric patient

Posted on December 11, 2019

Cerebral edema, or a swelling in the brain, is caused by the presence of excess fluid. A case report shows that hyperbaric oxygenation was able to treat acute cerebral edema in a pediatric patient by reducing intracranial pressure while increasing cerebral oxygenation. Through hyperbaric oxygen therapy's ability to decrease cerebral edema, maintain blood-brain barrier integrity, improve regional oxygen metabolism, and lower ICP and dialysate lactate levels a complete recovery was seen in the patient.

Clinical trials have favored hyperbaric oxygen therapy as a promising therapeutic treatment for adult patients with severe head injuries, but a case report proves HBOT to be a successful treatment option for a pediatric patient with brain edema characterized by the radiological appearance of Pseudosubarachnoid hemorrhage (PSAH).

The case report states a 10-year old previously healthy boy was admitted to the hospital after suffering from a headache and high fever for a course of two days. The patient experienced a 3-5 minute long, generalized tonic-clonic convulsion becoming unconscious 2-hours prior to admission. The patient received drug treatment however, his condition continued to worsen and intubation was required for airway protection. At 73-hours post admission, 100% oxygen was administered for 60-minutes at 2.0 absolute atmospheres. The initial therapy treatment allowed the patient to be extubated on day 4 of his hospitalization. The patient showed huge improvements from HBOT and by day 6 of hospitalization he was able to eat, occasionally say words, follow commands and display purposeful movements of his arms and legs. A total of 20 sessions of hyperbaric oxygen therapy was received with significant improvements in ambulation, balance, speech and cognition. The patient was discharged and at the one-year follow-up the patient had recovered completely and was able to resume school without apparent neurological sequelae.

Non-contrast head CT. (A) On day 1 of hospitalization, non-contrast head CT showed effacement of the basal cisterns and cortical sulci, collapse of the ventricles, poor gray matter-white matter differentiation, hyperdensity in the basal cisterns and interhemispheric fissure. (B) On day 2 of hospitalization, more obvious hyperdensity in the basal cisterns and more severe brain swelling were observed. (C) Following 3 days of HBOT (on day 6 of hospitalization), repeat CT showed re-opening of the basal cisterns and disappearance of hyperdensity. CT, computed tomography; HBOT, hyperbaric oxygen therapy.

For more information about pseduosubarachnoid hemorrhage or a thorough read of this case report click on https://www.ncbi.nlm.nih.gov/p....