Τίτλος:
Postoperative tetraplegia to a child after cerebellar pilocytic astrocytoma excision at prone position: Case report and literature review
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Objective: Unusual clinical course Background: Various factors have been implicated in the pathogenesis of infarction after posterior fossa surgery such as venous air embolism, patient’s position (seated or prone), hyperflexion of the neck, excessive spinal cord trac-tion, cervical canal stenosis, and systemic arterial hypotension. The main aim of this case report was to eluci-date a case in which hydrogen peroxide was implicated in a major and systemic complication after a neuro-surgical procedure. Case Report: We describe the case of a 5-year-old female patient who was admitted to our hospital because of a cerebel-lar hemispheric astrocytoma associated with obstructive hydrocephalus and accompanied by 2 syringomyelic cavities in the cervicothoracic portion of the spinal cord. Immediately after gross total resection of the lesion, impaired mobility of the upper and lower extremities was observed, a finding that was not consistent with in-traoperative neurophysiologic monitoring data. Hydrogen peroxide had been judiciously used to irrigate the resection tumor cavity. In the next few postoperative days, the patient suffered from transient diabetes insipidus and hyperpyrexia, indicative of hypothalamic injury. Conclusions: Neurological evaluation of the patient, after stabilization of her medical condition, revealed residual spastici-ty of upper and lower extremities, rendering her able to mobilize via the aid of wheelchair only. The most possible pathophysiologic explanation of her neurological deterioration, including hypothalamic dysfunction, was analyzed. The role of hydrogen peroxide as a source of free radical formation, and its co-responsibility for vascular platelet aggregation and vasoconstriction was considered, upon case review, the main responsible etio-logic factor. © Am J Case Rep, 2020.
Συγγραφείς:
Panagopoulos, D.
Antoniades, E.
Karydakis, P.
Giakoumettis, D.
Themistocleous, M.
Περιοδικό:
American Journal of Ophthalmology Case Reports
Εκδότης:
International Scientific Information, Inc.
Λέξεις-κλειδιά:
desmopressin; hydrogen peroxide; hydrogen peroxide, Article; balance disorder; brain infarction; brain injury; brain ischemia; cancer surgery; case report; cervical spine; child; clinical article; craniotomy; diabetes insipidus; disease course; dizziness; female; Greece; headache; histopathology; hospital admission; hospitalization; human; hyperpyrexia; hypothalamus; lavage; nervous system parameters; neuroimaging; neurologic examination; neurosurgery; nuclear magnetic resonance imaging; obstructive hydrocephalus; ophthalmoscopy; papilledema; physiotherapist; pilocytic astrocytoma; polyuria; postoperative complication; preschool child; prone position; quadriplegia; Romberg sign; spasticity; spine radiography; third ventriculostomy; thoracic spine; vomiting; water deprivation; adverse event; astrocytoma; cerebellum tumor; hydrocephalus; patient positioning; postoperative complication; prone position; quadriplegia, Astrocytoma; Cerebellar Neoplasms; Child, Preschool; Female; Humans; Hydrocephalus; Hydrogen Peroxide; Neurosurgical Procedures; Patient Positioning; Postoperative Complications; Prone Position; Quadriplegia
DOI:
10.12659/AJCR.920213
