Intraventricular hemorrhage as complication after spinal surgery. Case report
P Sánchez Zamora1, B Gómez Del Pulgar Vázquez1, S Gholamian Ovejero1
1Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain.
Revista Espanola De Anestesiologia Y Reanimacion
|March 11, 2022
Summary
Remote intracranial hemorrhage (ICH) is a rare complication after spinal surgery, often due to cerebrospinal fluid (CSF) loss. This case highlights intraventricular hemorrhage, presenting with neurological decline post-surgery.
Area of Science:
- Neurosurgery
- Neurology
- Anesthesiology
Background:
- Remote intracranial hemorrhage (ICH) is a rare but serious complication following spinal surgery.
- Pathophysiology involves cerebrospinal fluid (CSF) loss, often from incidental durotomy, leading to cerebral hypotension.
- While cerebellar ICH is common, intraventricular hemorrhage is less frequently reported.
Observation:
- The patient experienced neurological deterioration, including impaired awareness and seizures, in the immediate postoperative period after spinal surgery.
- Symptoms are often non-specific, mimicking other conditions and posing diagnostic challenges.
- Cerebral hypotension due to decreased CSF can lead to symptoms like headache, dysarthria, and hemiparesis.
Findings:
- This case presents a rare instance of intraventricular hemorrhage (IVH) in the right ventricle.
- The patient also exhibited cerebral and cerebellar edema.
- The hemorrhage occurred in the immediate postoperative period, complicating the diagnostic process.
Implications:
- Anesthesiologists must maintain a high index of suspicion for remote ICH in patients with unexplained neurological decline after spinal surgery.
- Prompt diagnosis and management are crucial for favorable outcomes.
- This case underscores the importance of considering IVH as a potential complication of spinal surgery, even when cerebellar ICH is more typical.
