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Intracranial Bleeding Following Induction of Anesthesia in a Patient Undergoing Elective Surgery for Refractory Epilepsy

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Intracranial Bleeding Following Induction of Anesthesia in a Patient Undergoing Elective Surgery for Refractory Epilepsy

Regunath Kandasamy et al. Surg Neurol Int.

Abstract

Background: A patient with refractory epilepsy due to underlying mesial temporal sclerosis underwent general anesthesia for an elective anterior temporal lobectomy and amgydalo-hippocampectomy. He was a known hypertensive and his blood pressure was well controlled on medication.

Case description: Following induction of general anesthesia and subsequent opening of the craniotomy flap it was noted that the patient had a very swollen brain that herniated out of the dural defect. There was an underlying spontaneous intraparenchymal bleed encountered in the region of the left temporal lobe with associated subarachnoid hemorrhage within the sylvian fissure. The clot was evacuated and subsequently brain swelling reduced allowing us to proceed with the intended surgery. Despite the intracranial findings there was no overt abnormality in the hemodynamic status from the time of induction of anesthesia to the craniotomy opening excepting a mild nonsustained elevation of blood pressure at the outset.

Conclusion: This case is of interest due to the fact that spontaneous intraparenchymal bleeding after induction of anesthesia has not been reported before in literature and should be considered in any patient in which brain swelling occurs in a setting of elective neurosurgery in which the primary lesion does not cause elevated intracranial pressure.

Keywords: Anesthesia technique – general anesthesia; complication – brain swelling; intraparenchymal hemorrhage.

Figures

Figure 1
Figure 1
(a-d) The brain is edematous with evidence of subarachnoid bleeding overlying the cortical surface upon opening the dura. Blood clots can be seen protruding out through a defect in the cortical surface (a). On further exploration, an intraparenchymal clot was noted in the region of the temporal lobe (b). Following evacuation of the clot, the brain appears more relaxed (c). A noncontrast computed tomographic image of the brain taken after the surgery reveals evidence of residual intraparenchymal clots in the temporal region

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