The case of a 20-year-old woman presenting with delayed, potentially fatal intracranial hypertension as a result of a head injury is reported. On admission, the patient had a Glasgow Coma Scale (GCS) score of 10. A brain CT scan showed an epidural hematoma in the left temporal region and a mild contusion of the bilateral frontal lobes. Two days after her injury, the patient's consciousness level suddenly deteriorated (GCS 4). Transcranial Doppler (TCD) examination disclosed a marked reduction (18cm/sec) in the velocity of the blood flow through the middle cerebral artery and a significant increase (2.11) in the pulsatility index. A second brain CT scan showed diffuse brain swelling but no changes in the size of the hematoma. The intracranial pressure (ICP) was 58mmHg. Although the cause of the acute brain swelling was unknown, moderate hypothermia therapy was initiated. The ICP was difficult to control during the hypothermia treatment but was maintained at above 20mmHg for most of the time. Hypothermia treatment was continued for 18 days before ICP control was regained. The patient was discharged with mild memory disturbances 4 months after admission. A literature, review has suggested that the TCD and ICP values of this patient could have been fatal. Thus, moderate hypothermia treatment may improve the outcome of potentially fatal intracranial hypertension.
