title: Cerebral vasospasm and ischemia after orbital decompression for graves ophthalmopathy.
abstract: OBJECTIVE
  We describe the first reported cases of cerebral vasospasm, ischemia, and infarct after orbital decompression surgery for Graves disease-related ophthalmopathy.
  
  
  METHODS
  We present two patients who had inadvertent penetration of the dura mater during orbital decompression surgery. One case was recognized at surgery; the other was not. All patient data were gathered and relayed in accordance with state and U.S. laws.
  
  
  RESULTS
  Postoperative cerebrospinal fluid leak, radiographic evidence of subarachnoid hemorrhage, and severe neurologic morbidity occurred in each case. Cerebral ischemia and infarction resulting from subarachnoid hemorrhage-induced cerebral vasospasm occurred in each case.
  
  
  CONCLUSIONS
  The risk of dural penetration, cerebral vasospasm, and ischemia should be considered during preoperative evaluation for orbital decompression surgery. The diagnosis, treatment, and prevention of this previously unreported serious complication of this procedure is paramount.
authors.affiliation: University of Utah Department of Ophthalmology, Salt Lake City, Utah, USA.
authors.forename: Chad D
authors.initials: CD
authors.lastname: McCormick
authors.forename: William H
authors.initials: WH
authors.lastname: Bearden
authors.forename: John H
authors.initials: JH
authors.lastname: Hunts
authors.forename: Richard L
authors.initials: RL
authors.lastname: Anderson
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology*; D002544:Cerebral Infarction / Q000175:diagnosis / Q000209:etiology; D019299:Decompression, Surgical / Q000009:adverse effects*; D005260:Female; D006111:Graves Disease / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000209:etiology; D014057:Tomography, X-Ray Computed; D020301:Vasospasm, Intracranial / Q000175:diagnosis / Q000209:etiology*