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Intracranial bleeding following induction of anesthesia in a patient undergoing elective surgery for refractory epilepsy.

Kandasamy R, Tharakan J, Idris Z, Abdullah JM - Surg Neurol Int (2013)

Bottom Line: There was an underlying spontaneous intraparenchymal bleed encountered in the region of the left temporal lobe with associated subarachnoid hemorrhage within the sylvian fissure.The clot was evacuated and subsequently brain swelling reduced allowing us to proceed with the intended surgery.This case is of interest due to the fact that spontaneous intraparenchymal bleeding after induction of anesthesia has not been reported before in literature and should be considered in any patient in which brain swelling occurs in a setting of elective neurosurgery in which the primary lesion does not cause elevated intracranial pressure.

View Article: PubMed Central - PubMed

Affiliation: Neurosurgical Division, Department of Neurosciences, Hospital Universiti Sains Malaysia, 16150, Kubang Kerian, Kota Bharu, Kelantan, Malaysia.

ABSTRACT

Background: A patient with refractory epilepsy due to underlying mesial temporal sclerosis underwent general anesthesia for an elective anterior temporal lobectomy and amgydalo-hippocampectomy. He was a known hypertensive and his blood pressure was well controlled on medication.

Case description: Following induction of general anesthesia and subsequent opening of the craniotomy flap it was noted that the patient had a very swollen brain that herniated out of the dural defect. There was an underlying spontaneous intraparenchymal bleed encountered in the region of the left temporal lobe with associated subarachnoid hemorrhage within the sylvian fissure. The clot was evacuated and subsequently brain swelling reduced allowing us to proceed with the intended surgery. Despite the intracranial findings there was no overt abnormality in the hemodynamic status from the time of induction of anesthesia to the craniotomy opening excepting a mild nonsustained elevation of blood pressure at the outset.

Conclusion: This case is of interest due to the fact that spontaneous intraparenchymal bleeding after induction of anesthesia has not been reported before in literature and should be considered in any patient in which brain swelling occurs in a setting of elective neurosurgery in which the primary lesion does not cause elevated intracranial pressure.

No MeSH data available.


Related in: MedlinePlus

(a-d) The brain is edematous with evidence of subarachnoid bleeding overlying the cortical surface upon opening the dura. Blood clots can be seen protruding out through a defect in the cortical surface (a). On further exploration, an intraparenchymal clot was noted in the region of the temporal lobe (b). Following evacuation of the clot, the brain appears more relaxed (c). A noncontrast computed tomographic image of the brain taken after the surgery reveals evidence of residual intraparenchymal clots in the temporal region
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Figure 1: (a-d) The brain is edematous with evidence of subarachnoid bleeding overlying the cortical surface upon opening the dura. Blood clots can be seen protruding out through a defect in the cortical surface (a). On further exploration, an intraparenchymal clot was noted in the region of the temporal lobe (b). Following evacuation of the clot, the brain appears more relaxed (c). A noncontrast computed tomographic image of the brain taken after the surgery reveals evidence of residual intraparenchymal clots in the temporal region

Mentions: Following craniotomy, it was noted that the dura and underlying brain was very tense. Upon durotomy, the brain bulged out and there was evidence of subarachnoid hemorrhage seen over the cortical surface. A transcortical approach was attempted via the medial temporal gyrus. During corticectomy, an intraparenchymal clot was encountered. The clot was evacuated and subsequently a left selective amygdalo-hippocampectomy was performed [Figure 1a-c].


Intracranial bleeding following induction of anesthesia in a patient undergoing elective surgery for refractory epilepsy.

Kandasamy R, Tharakan J, Idris Z, Abdullah JM - Surg Neurol Int (2013)

(a-d) The brain is edematous with evidence of subarachnoid bleeding overlying the cortical surface upon opening the dura. Blood clots can be seen protruding out through a defect in the cortical surface (a). On further exploration, an intraparenchymal clot was noted in the region of the temporal lobe (b). Following evacuation of the clot, the brain appears more relaxed (c). A noncontrast computed tomographic image of the brain taken after the surgery reveals evidence of residual intraparenchymal clots in the temporal region
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3814994&req=5

Figure 1: (a-d) The brain is edematous with evidence of subarachnoid bleeding overlying the cortical surface upon opening the dura. Blood clots can be seen protruding out through a defect in the cortical surface (a). On further exploration, an intraparenchymal clot was noted in the region of the temporal lobe (b). Following evacuation of the clot, the brain appears more relaxed (c). A noncontrast computed tomographic image of the brain taken after the surgery reveals evidence of residual intraparenchymal clots in the temporal region
Mentions: Following craniotomy, it was noted that the dura and underlying brain was very tense. Upon durotomy, the brain bulged out and there was evidence of subarachnoid hemorrhage seen over the cortical surface. A transcortical approach was attempted via the medial temporal gyrus. During corticectomy, an intraparenchymal clot was encountered. The clot was evacuated and subsequently a left selective amygdalo-hippocampectomy was performed [Figure 1a-c].

Bottom Line: There was an underlying spontaneous intraparenchymal bleed encountered in the region of the left temporal lobe with associated subarachnoid hemorrhage within the sylvian fissure.The clot was evacuated and subsequently brain swelling reduced allowing us to proceed with the intended surgery.This case is of interest due to the fact that spontaneous intraparenchymal bleeding after induction of anesthesia has not been reported before in literature and should be considered in any patient in which brain swelling occurs in a setting of elective neurosurgery in which the primary lesion does not cause elevated intracranial pressure.

View Article: PubMed Central - PubMed

Affiliation: Neurosurgical Division, Department of Neurosciences, Hospital Universiti Sains Malaysia, 16150, Kubang Kerian, Kota Bharu, Kelantan, Malaysia.

ABSTRACT

Background: A patient with refractory epilepsy due to underlying mesial temporal sclerosis underwent general anesthesia for an elective anterior temporal lobectomy and amgydalo-hippocampectomy. He was a known hypertensive and his blood pressure was well controlled on medication.

Case description: Following induction of general anesthesia and subsequent opening of the craniotomy flap it was noted that the patient had a very swollen brain that herniated out of the dural defect. There was an underlying spontaneous intraparenchymal bleed encountered in the region of the left temporal lobe with associated subarachnoid hemorrhage within the sylvian fissure. The clot was evacuated and subsequently brain swelling reduced allowing us to proceed with the intended surgery. Despite the intracranial findings there was no overt abnormality in the hemodynamic status from the time of induction of anesthesia to the craniotomy opening excepting a mild nonsustained elevation of blood pressure at the outset.

Conclusion: This case is of interest due to the fact that spontaneous intraparenchymal bleeding after induction of anesthesia has not been reported before in literature and should be considered in any patient in which brain swelling occurs in a setting of elective neurosurgery in which the primary lesion does not cause elevated intracranial pressure.

No MeSH data available.


Related in: MedlinePlus