title: Perioperative intracranial hemorrhage in achondroplasia: a case report.
abstract: We report a case of a 35-year-old man with achondroplasia who previously had thoracolumbar decompressive laminectomies, who developed recurrence of spinal stenosis at the thoracolumbar junction. The patient underwent standard repeat thoracolumbar decompression, removal of a disc, and spinal fusion with instrumentation in the prone position. Postoperatively the patient was confused. Computed tomography (CT) revealed hemorrhages in both cerebellar hemispheres with surrounding edema and mild mass effect. These were interpreted as venous hemorrhages. Conservative therapy was successful. This is the first case report of perioperative venous intracranial hemorrhage in the context of spinal surgery for achondroplasia. Distinctive anatomic characteristics of achondroplasia, combined with several potentially modifiable aspects of his management, may have predisposed the patient to this complication.
authors.affiliation: Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA.
authors.forename: I
authors.initials: I
authors.lastname: Elmaci
authors.forename: M C
authors.initials: MC
authors.lastname: Ain
authors.forename: M J
authors.initials: MJ
authors.lastname: Wright
authors.forename: R R
authors.initials: RR
authors.lastname: Lee
authors.forename: J M
authors.initials: JM
authors.lastname: Sheppard
authors.forename: D
authors.initials: D
authors.lastname: Rigamonti
authors.forename: O
authors.initials: O
authors.lastname: Hurko
mesh_terms: D000130:Achondroplasia / Q000150:complications*; D000328:Adult; D001929:Brain Edema; D003221:Confusion; D019299:Decompression, Surgical; D004906:Erythrocyte Count; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D006801:Humans; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D007431:Intraoperative Complications; D007796:Laminectomy; D008297:Male; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed