[Intracerebellar Hematoma following microsurgical STA-cortical MCA bypass surgery (author's transl)]

Since October 1967 we have performed 76 microsurgical STA--cortical MCA bypass operations. Recently we have had two cases, who died from intracerebellar hematoma following bypass operation. Intracerebellar hematoma is reported primarily due to hypertension (50-80%), and to comprise 10% of all spontaneous intracranial hematomas. Diagnosis of this lesion is frequently missed but can be made by the typical clinical picture (respiratory irregularity, pinpoint pupils, absence of oculovestibular responses, loss of consciousness), and the CT-Scan. If the correct diagnosis is made and operation promptly performed, many patients with subacute or acute intracerebellar hematoma can be saved. The 2 cases presented here had a history of hypertension and anticoagulation (including Colfarit), but had sustained the bypass operation well and showed no neurological deficit immediately after the operation. They had received Rheomacrodex intra- and postoperatively. Quite soon postoperatively, however, the systolic blood pressure rose to 210 mmHg and the patients complained of severe headache. They were treated symptomatically with analgesics and antihypertensive drugs. A short time later they became comatose and died. In order to prevent this complication after bypass surgery, postoperative management of hypertension is mandatory. The combination of antithrombic agents, Colfarit and Rheomacrodox, might have played a role in inducing the hemorrhages. Furthermore strong analgesics should be withheld to prevent their masking neurological deterioration. Intracerebellar hematoma must always be considered in hypertensive or anticoagulated patients, especially because it can be cured with prompt diagnosis and operative treatment.