Invasive Multimodality Neuromonitoring to Manage Cerebral Edema in Pediatric Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease

Nina A. Fainberg, MD; Maya R. Silver, MD; John D. Arena, MD; Elizabeth I. Landzberg, MD; Brenda Banwell, MD; Claudia Gambrah-Lyles, MD; Matthew P. Kirschen, MD, PhD; Peter J. Madsen, MD; Loren McLendon, MD; Sona Narula, MD; Alexander M. Tucker, MD; Jimmy W. Huh, MD; Martha F. Kienzle, MD

doi:10.1097/CCE.0000000000001003

Critical Care Explorations (Nov 2023)

Invasive Multimodality Neuromonitoring to Manage Cerebral Edema in Pediatric Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease

Nina A. Fainberg, MD,
Maya R. Silver, MD,
John D. Arena, MD,
Elizabeth I. Landzberg, MD,
Brenda Banwell, MD,
Claudia Gambrah-Lyles, MD,
Matthew P. Kirschen, MD, PhD,
Peter J. Madsen, MD,
Loren McLendon, MD,
Sona Narula, MD,
Alexander M. Tucker, MD,
Jimmy W. Huh, MD,
Martha F. Kienzle, MD

Affiliations

Nina A. Fainberg, MD: 1 Division of Critical Care Medicine, Children’s Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Maya R. Silver, MD: 2 Division of Child Neurology, Children’s Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
John D. Arena, MD: 3 Division of Neurosurgery, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Elizabeth I. Landzberg, MD: 1 Division of Critical Care Medicine, Children’s Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Brenda Banwell, MD: 2 Division of Child Neurology, Children’s Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Claudia Gambrah-Lyles, MD: 2 Division of Child Neurology, Children’s Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Matthew P. Kirschen, MD, PhD: 1 Division of Critical Care Medicine, Children’s Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Peter J. Madsen, MD: 3 Division of Neurosurgery, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Loren McLendon, MD: 4 Division of Child and Adolescent Neurology, Mayo Clinic College of Medicine and Science, Jacksonville, FL.
Sona Narula, MD: 2 Division of Child Neurology, Children’s Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Alexander M. Tucker, MD: 3 Division of Neurosurgery, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Jimmy W. Huh, MD: 1 Division of Critical Care Medicine, Children’s Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Martha F. Kienzle, MD: 1 Division of Critical Care Medicine, Children’s Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.

DOI: https://doi.org/10.1097/CCE.0000000000001003
Journal volume & issue: Vol. 5, no. 11
p. e1003

Abstract

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Background:. Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an inflammatory disorder of the CNS with a variety of clinical manifestations, including cerebral edema. Case Summary:. A 7-year-old boy presented with headaches, nausea, and somnolence. He was found to have cerebral edema that progressed to brainstem herniation. Invasive multimodality neuromonitoring was initiated to guide management of intracranial hypertension and cerebral hypoxia while he received empiric therapies for neuroinflammation. Workup revealed serum myelin oligodendrocyte glycoprotein antibodies. He survived with a favorable neurologic outcome. Conclusion:. We describe a child who presented with cerebral edema and was ultimately diagnosed with MOGAD. Much of his management was guided using data from invasive multimodality neuromonitoring. Invasive multimodality neuromonitoring may have utility in managing life-threatening cerebral edema due to neuroinflammation.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

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