Severe ischemic ECG changes, including significant ST segment depression, can occur in pediatric patients with severe head injury but may resolve upon surgical treatment of the underlying pathology.
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Severe ST depression may occur in pediatric head injury yet resolve with surgical treatment; hypothesis-generating and should not change practice.
Although ECG changes in subarachnoid hemorrhage and head injury have been described in adults, they have been rarely reported in children. We present 3 pediatric head-injured patients who developed severe ischemic changes on ECG. Three children (ages 9 months, 2.5 years, and 12 years) were admitted with severe head injury. All of them developed progressive ST segment depression of 4 to 7 mm during the surgical procedure. The first case, a 9-month-old child, also had bradycardia and cardiac arrest following ST depression. He was promptly resuscitated with simultaneous evacuation of extradural hematoma. In the other two cases, ST depression also gradually came up to baseline coinciding with surgical treatment of main pathology. All of the patients were ventilated postoperatively for 36 to 48 hours and discharged with no neurologic deficit. ECG changes and myocardial ischemia in head-injured patients have been attributed to extreme sympathetic stimulation and raised intracranial pressure in adults. But there has been no such systematic study in children. From our observations, we can conclude that ECG changes do occur in children with head injury, although the exact mechanism awaits further evaluation.
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Dash et al. (2003) studied this question.
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