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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

Postoperative computerized tomography brain showing subdural hematoma with mid line shift
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Related In: Results  -  Collection

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Figure 2: Postoperative computerized tomography brain showing subdural hematoma with mid line shift

Mentions: In ICU 1 unit of apheresis platelets was transfused. Repeat CT brain 24 h later showed 14 mm SDH with 7 mm midline shift with persistent uncal herniation [Figure 2]. One week later in the postoperative ward platelet count - 65,000 cells/mm3. The patient got discharged, advised medical follow-up.


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)

Postoperative 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 2: Postoperative computerized tomography brain showing subdural hematoma with mid line shift
Mentions: In ICU 1 unit of apheresis platelets was transfused. Repeat CT brain 24 h later showed 14 mm SDH with 7 mm midline shift with persistent uncal herniation [Figure 2]. One week later in the postoperative ward platelet count - 65,000 cells/mm3. The patient got discharged, advised medical follow-up.

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