Malignant infarcts is a well established cause of morbid raised ICP. The mainstay of management is osmotic diuresis and hyperosmolar therapy.Hyperventalation, hemicraniectomy and hypothermia have good outcomes. Phenobarbitals are used in cases of refractory raised ICP. We present a case of malignant Rt. MCA infarction where phenobarbital, instead of well established agents like pentobarbital and thiopental was used. The aim was to prevent cytotoxic edeme within 48 hrs of ictus. The desired effects of Phenobarbital was noted on repeat CT scan with restricted perilesional edema, without any significant drop in GCS. Neurological examination was possible, which is not possible with pentobarbital and thiopental and the patient did not rewuire ventilatory support.
Keywords: malignant infarct, raised ICP , cerebral edema, barbiturate coma,phenobarnbital
*Samarth Singh, MBBS, MD, FINS, MBA Head Department of Interventional Neurology, NeuroCardio & Multispeciality Hospital, Biratnagar, Nepal