ISSN 2379-1039 Intraparenchymal Haemorrhage After Burr .
Open Journal ofClinical & MedicalCase ReportsVolume 4 (2018)Issue 5ISSN 2379-1039Intraparenchymal haemorrhage after burr hole drainage: Acase report and review of literatureYao‐Lin Lee; Jinn‐Rung Kuo**Jinn-Rung Kuo, MDDepartment of Neurosurgery, Chi‐Mei Medical Center, 901 Chung Hwa Road, Yong Kang, TaiwanPhone: 886‐6‐2812811; Fax: 886‐6‐2828928; Email: kuojinnrung@gmail.comAbstractIntraparenchymal haemorrhage after burr hole drainage for the treatment of chronic subduralhaemorrhage is a complication that should not be over looked. Here we report a case of a 93 years‐oldman with a history of hypertension under medical control who suffered progressive left hemiparesisover the course of three days. His brain CT showed bilateral subacute subdural hematomas, so wearranged bilateral burr hole drainage with placement of frontal subdural closed drainage systems oneach side. His perioperative blood pressure remained in normal range. However, on the irstpostoperative day the patient's muscle power declined on the left side and his consciousness becamedrowsy. Hypertension with bradycardia ensued in this patient which suggested increased intracranialpressure. This prompted a follow up MRI which showed intraparenchymal haemorrhage at the rightlentiform nucleus. CTA showed no vascular malformation or neoplasm, nor hemorrhagic diathesis, andthe patient's preoperative coagulation parameters were normal. Although a hypertensive historyincreases the risk for spontaneous ICH in this area, we cannot rule out an increased risk due to thesurgical procedure or the anesthetic process. The patient was given hydration and bed rest, as well asmedication for blood pressure control. There was no further neurological decline and both drainagetubes were removed six days postoperatively. This case raises awareness that intraparenchymalhemorrhage in a procedure such as the burr hole craniotomy is possible, and its cause may be related tothe patient's hypertension, to the opening of the drainage system or the relief of intracranial pressurefrom the burr hole procedure itself.Keywordschronic subdural hemorrhage; burr hole drainage; putaminal hemorrhageAbbreviationsCT: Computed Tomography; CTA: Computed Tomography Angiography; SDH: Subdural HematomaIntroductionSubdural hematoma (SDH) is blood forming in the space between the dura and arachnoid [1].Head trauma is the most common cause of SDH, and chronic SDH is most commonly seen in the elderly[1,2,3]. It is a condition more common in older adults due to the stretching and weakening of bridgingveins in an atrophic brain. It occurs bilaterally in 19% of all cases and is more common in the male sexOpen J Clin Med Case Rep: Volume 4 (2018)Kuo JR
Vol 4: Issue 5: 1384[4,5]. A haematoma develops when bridging veins are torn, usually due to a head injury [6]. Typicaltreatment for symptomatic subacute or chronic SDH is to undergo a burr hole craniotomy for the releaseof subdural blood collection [7]. This procedure is relatively low risk and effective and consists of drillinga hole in the skull and draining the lique ied blood through a drainage tube or with sterile salineirrigation [8]. Usually after drainage of a SDH, 80 to 90 percent of patients show signi icant improvementin brain function [9]. Here we report a case of intraparenchymal haemorrhage at the right lentiformnucleus after bilateral burr hole craniotomy for bilateral subacute subdural hematoma. In addition topresenting the clinical course of an unusual case, we will discuss the possible mechanisms of intracranialhaemorrhage after burrhole drainage.Case ReportThis is a case of a 93 years‐old man with a known history of prostate cancer, stage III, status posthormone and radio therapy. He also has hypertension currently under medical control. He was found byhis family to exhibit progressive left hemiparesis over the course of three days. On the third day, he fellfrom his bed in the morning due to left‐sided weakness and was brought to our ER. Tracing back to hisrec
8. Kenning TJ, Dalino JC, German JW, Drazin D, Adamo MA.Analysis of the subdural evacuating port system for the treatment of subacute and chronic subdural hematomas. J Neurosurg. 2010; 113 (5):1004–10. 9. Ivamoto HS, Lemos HP Jr, Atallah AN. Surgical Treatment for Chronic Subdur
Product Data Sheet for Item # 2379 CHEDDAR CHEESE SAVORY Product Name and Number: 2379 Cheddar Cheese Savory Document #: 17.4.5.11.1 . Organisms considered food-borne pathogens or of concern from a quality standpoint are not able to proliferate in this product; the processing and packaging is completed in a closed and sealed system offering .
A unique case of hormone receptor-positive breast cancer metastasis to kidney responsive to endocrine therapy Ami Patel, MD*; Rita Blanchard, MD *Ami Patel, MD Department of Hematology/Oncology, Boston University Medical Center, USA Email: ami_patel@dfci.harvard.edu Abstract Renal metastasis from breast cancer is very rare and often asymptomatic.
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complications, such as HELLP-syndrome (haemolysis, elevated liver enzymes, low platelet counts), pulmonary edema, acute renal failure, liver failure or haemorrhage, abruptio placentae and eclampsia. The major cause of maternal death is cerebral haemorrhage. Pre-eclampsia is also associated with increased perinatal morbidity and mortality. .
the evidence of Dr Milne is allowed in part. 2. Subject to the submissions of the parties as to the form of rulings in relation to the evidence of Dr Milne: (1) Dr Milne may give evidence of his observation of a probable haemorrhage on the interior left chest wall (“the chest haemorrhage”).
1.9. There is insufficient evidence for the use of recombinant factor VIIa in acute variceal haemorrhage (level 1b, grade B). 2. Suggestions for timing of upper gastrointestinal endoscopy: 2.1. Offer endoscopy to unstable patients with severe acute upper gastrointestinal bleeding immediately after resusci-tation (level 5, grade A). 2.2.
The majority of postpartum haemorrhage (PPH) maternal deaths could be avoided by the use of prophylactic uterotonics during the third stage of labour. To meet the ambitious maternal health targets of the Sustainable Development Goals, specifically SDG 3.1: reduce the global maternal mortality ratio to less than 70/100,000 live births by 2030.
Nutrition of ruminants Developing production systems for ruminants using tropical feed resources requires an understanding of the relative roles and nutrient needs of the two-compartment system represented by the symbiotic relationship between rumen micro-organisms and the host animal. Fibre-rich, low-protein forages and crop residues are the most abundant and appropriate feeds for ruminants .
