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Hyperhomocysteinemia and Evan's syndrome with uncal herniation for emergency splenectomy.

Shivalingaiah SK, Arpana J, Jain MK, Varghese VK - Anesth Essays Res (2015 Jan-Apr)

Bottom Line: A 26-year-old male, a known case of hyperhomocyteinemia on medication for 4 years, came with a history of severe headache, blurring of vision and bleeding gums.Because he was refractory to the medical management, taken up for emergency splenectomy, followed by burr hole evacuation of SDH.Successful anesthetic management of the case is presented in this report.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia, St. John's Medical College Hospital, Bengaluru, Karnataka, India.

ABSTRACT
Hyperhomocysteinemia is a genetic disorder of metabolism and transport of amino acid, commonly present as a pro-coagulant state. Evan's syndrome is an autoimmune disorder with pancytopenia, a diagnosis of exclusion. The present report highlights the anesthetic management of a rare case, where both these clinical entities coexist. A 26-year-old male, a known case of hyperhomocyteinemia on medication for 4 years, came with a history of severe headache, blurring of vision and bleeding gums. Computerized tomography brain report showed subdural hematoma (SDH) of 16 mm with 9 mm right midline shift and on investigation had thrombocytopenia (5000 cells/cumm). Patient was diagnosed to have Evan's syndrome. Because he was refractory to the medical management, taken up for emergency splenectomy, followed by burr hole evacuation of SDH. Successful anesthetic management of the case is presented in this report.

No MeSH data available.


Related in: MedlinePlus

Preoperative computerized tomography brain showing subdural hematoma with mid line shift
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Figure 1: Preoperative computerized tomography brain showing subdural hematoma with mid line shift

Mentions: A 26-year-old male weighing 58 kg, known case of hyperhomocystienemia on tablet warfarin for 4 years presented with severe headache (1-month), blurring of vision and bleeding gums. Pallor and petechiae were present on examination. On investigation: Hemoglobin (Hb) - 4 g%, white blood cell - 2800 cells/cumm, platelets - 5000 cells/mm3 and international normalized ratio (INR) - 2.9. Direct and indirect Coomb's test: Positive. Findings confirmed Evan's syndrome. Fundoscopic eye examination: Dense periretinal and vitreous hemorrhage. Computerized tomography (CT) brain: Left fronto temporo parietal acute on chronic subdural hematoma (SDH) of 16 mm with 9 mm right midline shift [Figure 1].


Hyperhomocysteinemia and Evan's syndrome with uncal herniation for emergency splenectomy.

Shivalingaiah SK, Arpana J, Jain MK, Varghese VK - Anesth Essays Res (2015 Jan-Apr)

Preoperative computerized tomography brain showing subdural hematoma with mid line shift
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4383129&req=5

Figure 1: Preoperative computerized tomography brain showing subdural hematoma with mid line shift
Mentions: A 26-year-old male weighing 58 kg, known case of hyperhomocystienemia on tablet warfarin for 4 years presented with severe headache (1-month), blurring of vision and bleeding gums. Pallor and petechiae were present on examination. On investigation: Hemoglobin (Hb) - 4 g%, white blood cell - 2800 cells/cumm, platelets - 5000 cells/mm3 and international normalized ratio (INR) - 2.9. Direct and indirect Coomb's test: Positive. Findings confirmed Evan's syndrome. Fundoscopic eye examination: Dense periretinal and vitreous hemorrhage. Computerized tomography (CT) brain: Left fronto temporo parietal acute on chronic subdural hematoma (SDH) of 16 mm with 9 mm right midline shift [Figure 1].

Bottom Line: A 26-year-old male, a known case of hyperhomocyteinemia on medication for 4 years, came with a history of severe headache, blurring of vision and bleeding gums.Because he was refractory to the medical management, taken up for emergency splenectomy, followed by burr hole evacuation of SDH.Successful anesthetic management of the case is presented in this report.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia, St. John's Medical College Hospital, Bengaluru, Karnataka, India.

ABSTRACT
Hyperhomocysteinemia is a genetic disorder of metabolism and transport of amino acid, commonly present as a pro-coagulant state. Evan's syndrome is an autoimmune disorder with pancytopenia, a diagnosis of exclusion. The present report highlights the anesthetic management of a rare case, where both these clinical entities coexist. A 26-year-old male, a known case of hyperhomocyteinemia on medication for 4 years, came with a history of severe headache, blurring of vision and bleeding gums. Computerized tomography brain report showed subdural hematoma (SDH) of 16 mm with 9 mm right midline shift and on investigation had thrombocytopenia (5000 cells/cumm). Patient was diagnosed to have Evan's syndrome. Because he was refractory to the medical management, taken up for emergency splenectomy, followed by burr hole evacuation of SDH. Successful anesthetic management of the case is presented in this report.

No MeSH data available.


Related in: MedlinePlus