Remote site intracranial hemorrhage: our experience and review of literature.

Abstract

Sudden decompression in a patient with chronically raised intracranial pressure (ICP) can very rarely lead to bleeding away from the operative site. In this retrospective review the intention is to highlight the possible causes of remote bleed. Data of six patients with remote site bleed in the postoperative period operated at our center were retrospectively reviewed. Medline and Pubmed databases were searched for similar cases and were reviewed systematically to understand the cause, management, and outcome. In our series the mean age of patients was 35.5 years. Three patients each were operated for supratentorial and infratentorial pathologies. Of the six patients, three patients were operated for tumors. Of the 89 patients with remote site bleed in the postoperative period,64 (72%) patients had supratentorial tentorial and in the remaining it was infratentorial surgery. Most common site of bleed was supratentorial in 72 {81 %) patients. The reported mortality was 28% (21 patients). Remote site intracranial bleed following cranial surgery is a rare but well-documented complication. It can prove fatal and may cause significant morbidity. We advocate keeping high index of suspicion and ear[y computed tomography(CT) scan head in postoperative period.