title: Lethal recurrent hemorrhages of a brainstem cavernoma.
abstract: Hemorrhages of brainstem cavernomas may cause severe neurological deficits. Surgical strategies are frequently described, and advanced neuromonitoring with intraoperative imaging can help neurosurgeons to achieve good results. However, patients are often confronted with significant therapeutic risks by the primary doctor before talking to an experienced brainstem neurosurgeon. On the other hand, lethal progression with repeated hemorrhages is rarely described, although many would agree on this possibility by experience or assumption. Our reported case represents the natural development of a patient with repeated hemorrhages of a brainstem cavernoma and consequently increasing neurological deterioration, which led to a fatal ending. After two recurrent hemorrhages, the patient and his family declined twice the offered surgical procedures to evacuate the hematoma of the pons. The patient died after three noticed hemorrhages of the same brainstem cavernoma and their consecutive consequences. This case report represents one possible clinical scenario for consultation for brainstem cavernoma procedures.
authors.affiliation: First Neurosurgical Clinic, Bagdasar-Arseni Emergency Clinic Hospital, Bucharest, Romania.
authors.forename: Alexandru Vlad
authors.initials: AV
authors.lastname: Ciurea
authors.forename: Cristian
authors.initials: C
authors.lastname: Nastase
authors.forename: Alexandru
authors.initials: A
authors.lastname: Tascu
authors.forename: Felix Mircea
authors.initials: FM
authors.lastname: Brehar
mesh_terms: D000328:Adult; D020295:Brain Stem Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000209:etiology*; D017809:Fatal Outcome; D006392:Hemangioma, Cavernous / Q000150:complications* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures; D011149:Pons / Q000473:pathology / Q000601:surgery; D012008:Recurrence; D014057:Tomography, X-Ray Computed