Breath-holding spells after endoscopic third ventriculostomy in a post-ventriculoperitoneal shunted patient

Area of Science:

• Pediatric Neurology
• Autonomic Nervous System Disorders
• Neurosurgery

Background:

• Breath-holding spells (BHS) are common autonomic nervous system disorders in children, often triggered by emotional distress or pain.
• Cyanotic BHS is a recognized subtype.
• Endoscopic third ventriculostomy (ETV) is a neurosurgical procedure.

Observation:

• A 3-year-old girl developed BHS two weeks post-ETV.
• The patient experienced a delayed adaptation period with severe headache, indicative of increased intracranial pressure (ICP).
• This ICP elevation is hypothesized to have precipitated the BHS.

Findings:

• Management focused on symptom control and addressing the causative factor (increased ICP).
• Intensive pain management and ICP reduction were effective in resolving the BHS.
• The case demonstrates an atypical presentation of BHS in a pediatric neurosurgical context.

Implications:

• Highlights the importance of recognizing BHS as a potential atypical symptom post-neurosurgery.
• Suggests monitoring for BHS in pediatric patients with delayed adaptation and signs of increased ICP.
• Underscores the need for prompt management of elevated ICP to prevent complications like BHS.