Successful treatment with hyperbaric oxygen therapy for severe brain edema characterized by radiological appearance of pseudosubarachnoid hemorrhage in a child

Pseudosubarachnoid hemorrhage (PSAH) is a rare neuroradiological finding, particularly in pediatric patients. The appearance of PSAH is commonly associated with poor clinical outcome due to refractory cerebral edema. Recent clinical trials have favored hyperbaric oxygen therapy (HBOT) as a promising therapeutic strategy for adult patients with severe head injuries. The present report describes a pediatric case of diffuse brain edema characterized by the radiological appearance of PSAH successfully treated with HBOT. An adolescent boy collapsed unconscious following convulsion for 3-5 min with fever and headache for 2 days. A brain computed tomography (CT) scan provided an image compatible with subarachnoid hemorrhage (SAH). Lumbar puncture was conducted on admission to hospital and showed no evidence of SAH. The CT scan was again considered and eventually interpreted as PSAH. The patient received drug treatment including acyclovir and mannitol, but the condition deteriorated rapidly. HBOT was administered at 72 h post admission and the condition was clearly improved following the initial therapy. The patient was discharged with 20 sessions of HBOT and recovered completely after 1 year. The appearance of PSAH indicates severe cerebral edema refractory to treatment with conventional internal medicine. HBOT maybe an effective therapeutic strategy for this condition.