Near-fatal asthma in a 12-year-old girl leading to life-threatening tonsillar herniation: a case report

Background Severe asthma exacerbations can lead to rare and life-threatening complications such as cerebral edema and tonsillar herniation. This case highlights the importance of early recognition, aggressive treatment, and the implementation of standardized pediatric intensive care unit protocols for managing critical asthma complications. Case presentation We report the case of a 12-year-old girl of Middle Eastern descent from Saudi Arabia with a history of bronchial asthma and allergic rhinitis who developed cerebral edema and resultant tonsillar herniation following a severe asthma exacerbation. Her presentation was marked by respiratory distress unresponsive to initial therapy. Intensive management in the pediatric intensive care unit including mechanical ventilation and neuroprotective measures resulted in full neurological recovery prior to discharge. Conclusion This case underscores the need for prompt identification and multidisciplinary management of severe asthma complications in pediatric patients to prevent irreversible outcomes.