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Death from cardiac failure in a child with ruptured cerebral arteriovenous malformation

Kevin S Haug1, Barry G Baylen, Richard B Mink

  • 1Department of Pediatrics, Division of Pediatric Critical Care, David Geffen School of Medicine at UCLA, Torrance, CA, USA. kevin.haug@ucdmc.ucdavis.edu

Pediatric Emergency Care
|May 16, 2009
PubMed

Insights

A ruptured cerebral arteriovenous malformation in a child caused severe cardiac failure and death. This case highlights the critical, potentially lethal cardiovascular risks in pediatric patients following a cerebral insult.

Area of Science:

  • Neurology
  • Cardiology
  • Pediatrics

Background:

  • Cardiac dysfunction following neurological injury, known as neurogenic stunned myocardium, is well-documented in adults with subarachnoid hemorrhage.
  • Cardiovascular complications in children after brain injury are less common and typically associated with traumatic brain injury, with no reported fatalities.

Observation:

  • A 13-year-old boy experienced rapid cardiac failure and death following a ruptured cerebral arteriovenous malformation (AVM) with subarachnoid hemorrhage.
  • Diagnostic data, including electrocardiograms, cardiac enzymes, echocardiograms, and pulmonary artery catheterization, confirmed severe ventricular dysfunction due to myocardial ischemia and infarction.

Findings:

  • This case demonstrates a fatal outcome in a pediatric patient due to severe cardiac dysfunction after a ruptured cerebral AVM.
  • The event suggests that ruptured cerebral AVMs can precipitate life-threatening cardiac complications in children, mirroring but exceeding the severity seen in other pediatric brain injuries.

Implications:

  • Early recognition and management of cardiac dysfunction are crucial in pediatric patients with ruptured cerebral AVMs and subarachnoid hemorrhage.
  • Aggressive supportive care is necessary to maintain adequate perfusion and limit secondary brain injury in these high-risk pediatric cases.

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