Cases reported "Postoperative Hemorrhage"

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1/18. Multiple postoperative intracerebral haematomas remote from the site of craniotomy.

    A postoperative haemorrhage is a common and serious complication of a neurosurgical procedure. It usually occurs at the site of the surgery, but on occasion a postoperative haematoma is found at a distance from the previous craniotomy. Multiple postoperative haemorrhages are extremely rare. We report the case of a 63-year-old woman, operated on for the removal of a supratentorial astrocytoma, who developed in the early post-operative period multiple bilateral intracerebral haematomas without involvement of the surgical bed.
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ranking = 1
keywords = supratentorial
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2/18. Cerebellar hemorrhage after supratentorial surgery for treatment of epilepsy: report of three cases.

    OBJECTIVE AND IMPORTANCE: We report three cases of cerebellar hemorrhage complicating supratentorial craniotomies for the treatment of epilepsy. In a literature review, we identified only four similar cases of cerebellar hemorrhage after temporal lobectomy for the treatment of epilepsy. CLINICAL PRESENTATION AND RESULTS: Three young and otherwise healthy patients underwent frontal, occipital, and temporal resections for the treatment of refractory epilepsy. The hemorrhage manifested as peduncular tremor, ataxia, and decerebrate posturing presenting early in the postoperative period. The diagnosis was established by computed tomography and/or magnetic resonance imaging. Benign outcomes were observed for all patients. CONCLUSION: Based on the available data, it is our opinion that brain dislocation resulting from excessive intraoperative cerebrospinal fluid drainage is a possible mechanism for this rare complication of supratentorial craniotomy. The overdrainage seems to be less hazardous when the procedure is performed for the removal of space-occupying mass lesions. In contrast, the resection of nonexpanding tissues, such as in lobectomies for the treatment of epilepsy, may be an additional risk factor, because the incidence of this complication seems to be higher in these situations.
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ranking = 6
keywords = supratentorial
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3/18. Cerebellar haemorrhage after evacuation of an acute supratentorial subdural haematoma.

    Recent reports have highlighted the unusual complication of distant cerebellar haemorrhage after supratentorial craniotomy, with only 25 previous cases reported in the literature. Nearly all reported cases occurred after craniotomy for temporal lobectomy or for deep seated intracerebral pathology requiring brain retraction and removal of CSF at surgery. Only one previous case of a cerebellar haemorrhage after evacuation of an extracerebral fluid collection has been reported. We describe the case of a cerebellar haemorrhage complicating the evacuation of an acute/subacute supratentorial subdural haematoma in a 83-year-old woman. The literature is reviewed and possible mechanisms of haemorrhage discussed.
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ranking = 6
keywords = supratentorial
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4/18. F-18 FDG uptake in breast infection and inflammation.

    PURPOSE: Whole-body fluorine-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography (PET) scanning has been useful in the management of breast cancer. However, F-18 FDG uptake sometimes has been associated with benign breast disease. Four cases are reported of F-18 FDG breast uptake caused by infectious or inflammatory mastitis that mimics malignant disease. methods AND RESULTS: Two women had F-18 FDG whole-body scans for the evaluation of a large breast mass after inconclusive results of ultrasonography. In both cases, intense focal F-18 FDG breast uptake was noted that mimicked breast cancer. Histologic examination showed, in one patient, chronic granulomatous infiltration that likely represented tuberculous mastitis, because she showed a good clinical response to empirical anti-tuberculous treatment. The second patient had lactational changes associated with acute inflammation, and the culture grew staphylococcus aureus. The breast mass completely disappeared 3 weeks after a course of antibiotic treatment. The other two patients had staging F-18 FDG PET scans 1 and 12 months after lumpectomy for breast carcinoma to detect residual, recurrent, or metastatic disease. Both scans showed a ring-like uptake in the involved breast, with superimposed intense focal uptake suggesting tumor necrosis centrally and malignant foci peripherally. In both cases, histologic examination revealed hemorrhagic inflammation secondary to postsurgical hematomas and no evidence of malignancy. CONCLUSION: Acute or chronic infectious mastitis and postsurgical hemorrhagic inflammatory mastitis should be considered in patients who have a breast mass, especially those with a history of tenderness or surgery.
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ranking = 0.00027625490590361
keywords = cancer
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5/18. Migration of steel-wire coils into the stomach after transcatheter arterial embolization for a bleeding splenic artery pseudoaneurysm: report of a case.

    Transcatheter arterial embolization (TAE) represents the primary, and often definitive, mode of therapy for bleeding splanchnic artery pseudoaneurysms (PSA). Nevertheless, a number of complications associated with this procedure have been described. We report herein the case of a 59-year-old man with chronic pancreatitis who was referred to us with hematemesis and hemorrhagic shock. Computed tomography revealed a splenic artery PSA bleeding into a pancreatic pseudocyst, and TAE was performed using steel-wire coils, placed inside the aneurysmal cavity, which resulted in the immediate cessation of bleeding. However, several weeks later some of the coils were found to have dislodged through a gastropseudocystic fistula. Furthermore, an early gastric cancer was incidentally found proximal to the fistula. We finally performed open surgery to treat both disorders; primarily for the gastric cancer, but also for the pseudocyst and fistula, with the intermittent discharge of the steel-wire coils. To our knowledge, migration into the stomach of steel-wire coils after TAE has not been described before. It is generally believed that the embolization procedure should occlude normal portions of the artery both distal and proximal to the PSA with embolization materials. By occluding the PSA in this way, the subsequent migration of steel-wire coils into the pseudocyst and stomach might have been prevented in our patient.
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ranking = 0.00027625490590361
keywords = cancer
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6/18. Tentorial vascularization in solid hemangioblastoma--case report.

    A 40-year-old female was admitted to the hospital with complaints of headache worsening gradually over a 1-month duration. Her past history included surgery to treat a left cerebellar cystic lesion 3 years before, and an untreated small solid right supracerebellar lesion of 1 cm diameter. On admission, magnetic resonance imaging showed that the right cerebellar lesion had grown to approximately 4 cm diameter abutting the tentorium and causing obstructive hydrocephalus. She also had two more small lesions, a right supratentorial solid lesion with cystic component near the splenium and an intramedullary cystic lesion at the C-2 level. Right suboccipital craniectomy was done. The vascular attachments between the superior aspect of the tumor and the tentorium were coagulated and the tumor was totally removed. C1-2 laminectomy was also performed to drain the intramedullary cyst. The patient deteriorated and lost consciousness with respiratory arrest 6 hours postoperatively and was reoperated for intracerebellar hematoma due to oozing from the tentorial vessels. Histological investigation revealed hemangioblastoma. Dural tentorial vascular attachments in solid hemangioblastomas located subjacent to the tentorium may cause early postoperative complications of hematoma at the site of vascular attachment following the resection. Computed tomography study in the early postoperative period is helpful to identify this problem.
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ranking = 1
keywords = supratentorial
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7/18. Cerebellar haemorrhage after supratentorial aneurysm surgery with lumbar drainage.

    Haemorrhage within the posterior fossa (PF) after supratentorial surgery is a very rare and exceedingly dangerous complication. Only 28 cases were found in the literature. Up to now, no pathogenetic factor has decisively proven to be the cause of this phenomenon. We present clinical details of a patient operated on for aneurysm of the anterior communicating artery. Lumbar drainage was used during surgery, with the loss of a large amount of cerebrospinal fluid (200 ml). Other causes in our case which may have led to cerebellar shift or a critical increase in transmural venous pressure with subsequent vascular disruption and haemorrhage were extreme head rotation during lengthy surgery and blood pressure peaks in the early postoperative period. Repeated computed tomography (CT) allowed immediate diagnosis of this complication and control of its conservative management. After postponed ventriculoperitoneal shunt, the patient recovered completely.
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ranking = 5
keywords = supratentorial
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8/18. Cerebellar hemorrhage arising postoperatively as a complication of supratentorial surgery: a retrospective study.

    OBJECT: Postoperative cerebellar hemorrhage as a complication of supratentorial surgery is an increasingly recognized clinical entity. So far, it has remained unclear whether this complication constitutes an intraoperative or postoperative event. The observation of such cases prompted the authors to analyze retrospectively their series of supratentorial craniotomies. The aim of this study was to determine the incidence of cerebellar hemorrhage and its temporal relationship to supratentorial surgery. methods: The authors reviewed discharge notes and reports on postoperative computerized tomography (CT) scans for 1650 patients who had undergone supratentorial craniotomy between January 1998 and February 2001. The retrospective study led to the identification of 10 patients who had sustained cerebellar hemorrhage as a complication of supratentorial surgery. Because it was routine to perform CT scanning following craniotomy, an early CT scan obtained within the 1st postoperative hour (mean 24 minutes after wound closure) was available in eight of the 10 patients. In seven of these patients no hemorrhage was found immediately after surgery, and in only one patient was there the suspicion of cerebellar hemorrhage. In the whole series of 10 patients, cerebellar hemorrhage was detected during the later postoperative course, after a mean interval of 7 hours and 35 minutes (range 1 hour and 49 minutes-144 hours) following surgery. The incidence of cerebellar hemorrhage was 0.6% of all patients who underwent supratentorial surgery. Among patients suffering from epilepsy the incidence was 4.6%, and in those patients who underwent temporal lobe resection it was 12.9%. CONCLUSIONS: The authors have demonstrated that cerebellar hemorrhage as a complication of supratentorial surgery arises not as an intraoperative event, but as a postoperative event. Resective nontumorous temporal lobe procedures place patients at particular risk for this complication. Evidence suggests that the complication might be precipitated by postoperative suction drainage.
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ranking = 11
keywords = supratentorial
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9/18. Cerebellar hemorrhage after supratentorial craniotomy.

    BACKGROUND: Cerebellar hemorrhage following supratentorial craniotomy is a very seldom described but serious complication. The present study evaluates the significance of presurgical and surgical factors that may predispose patients to these bleeding episodes. methods: The data of 52 cases of cerebellar hemorrhage following supratentorial craniotomy, 9 from our records and 43 from the literature, were analyzed with regard to various variables. RESULTS: The findings suggest that this clinical picture is unrelated to age, previous arterial hypertension, inherent or induced coagulopathies, type of primary underlying lesion, intraoperative positioning of the patient, type of anesthesia, or intracranial hypotension and its sequels. It entails significant morbidity, with one third of the patients left with cerebellar dysfunction or in a dependent state, and carries a mortality of about 25%. CONCLUSION: Not one single presurgical or surgical factor can reliably predict the occurrence of cerebellar hemorrhage after supratentorial craniotomy, and the etiology of this entity still remains unclear. The most important keys to minimize the hazardous sequelae are to be aware of this potential complication and to diagnose it early.
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ranking = 7
keywords = supratentorial
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10/18. Pontine hemorrhage after frontal craniotomy. Report of a case.

    This report describes the complication of pontine hemorrhage in a patient who had undergone supratentorial craniotomy for treatment of a frontal intracerebral hematoma. A literature review revealed no previous cases of pontine hemorrhage in this clinical scenario. Abnormal findings on neurological examination in the early postoperative period should alert the physician to the possibility of this complication.
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ranking = 1
keywords = supratentorial
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