title: Large cerebellar hemorrhage during trumpet playing: importance of blood pressure elevation during the valsalva maneuver: case report.
abstract: OBJECTIVE
  The authors report a case of a large intracerebellar hemorrhage that occurred in a professional musician while playing the trumpet. This is the first report of such a complication.
  
  
  METHODS
  A 60-year-old man presented with severe occipital headache accompanied by nausea, vomiting, and dizziness that occurred while he was practicing the trumpet. On presentation, he was hypertensive with a systolic blood pressure of 255 mmHg and was found to have a large left cerebellar hemorrhage.
  
  
  METHODS
  Magnetic resonance imaging and magnetic resonance angiography were performed but revealed no tumor or vascular abnormality. The patient was initially stable but, despite maximal medical therapy, deteriorated and was taken to the operating room for suboccipital craniectomy and evacuation of the hematoma.
  
  
  CONCLUSIONS
  This patient likely had chronic hypertension; however, the transient increase in systolic blood pressure associated with intensive trumpet playing and the Valsalva maneuver may have contributed to his risk of hemorrhage. We suggest that hypertensive screening and therapy may be especially important in this population and emphasize the importance for neurosurgeons to understand the physiology involved in the Valsalva maneuver.
authors.affiliation: Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, USA.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Carlson
authors.forename: Suguna
authors.initials: S
authors.lastname: Pappu
authors.forename: Marcus F
authors.initials: MF
authors.lastname: Keep
authors.forename: Paul
authors.initials: P
authors.lastname: Turner
mesh_terms: D002531:Cerebellum; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology*; D019586:Intracranial Hypertension / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009146:Music; D014636:Valsalva Maneuver / Q000502:physiology*