Subarachnoid hemorrhage following uneventful thyroid orbital decompression

Area of Science:

• Ophthalmology
• Neurosurgery
• Endocrinology

Background:

• Thyroid-related immune orbitopathy often requires surgical intervention, such as transconjunctival orbital decompression.
• Orbital decompression aims to alleviate symptoms by reducing intraorbital pressure.

Observation:

• A 24-year-old woman underwent uneventful right transconjunctival orbital decompression for thyroid-related immune orbitopathy.
• Post-operatively, the patient developed subarachnoid hemorrhage and left frontal lobe ischemia.

Findings:

• Diagnostic imaging, including CT, MRI, CT angiography, and carotid angiography, confirmed the hemorrhage and ischemia.
• No underlying cerebral vascular abnormalities were identified as a cause.
• The patient experienced a full recovery within 4 months.

Implications:

• This case highlights a potential, albeit rare, neurological complication following orbital decompression surgery.
• Clinicians should maintain a high index of suspicion for subarachnoid hemorrhage and ischemia in patients with thyroid-related immune orbitopathy post-surgery.
• Further investigation into the specific mechanisms linking orbital decompression and these neurological events may be warranted.