title: Multiple supratentorial intraparenchymal hemorrhage after posterior fossa surgery.
abstract: BACKGROUND
  The intraparenchymal supratentorial hemorrhages after interventions of the posterior fossa is a very rare complication, with very little literature and its precise incidence is unknown (range of 0.4-1.6%). It possesses potentially an etiology diverse from that associated with other postoperative bleeding.
  
  
  METHODS
  A white, 23-year-old female, with no history of coagulation disorders or other diseases, was referred to our hospital with a large ependymoma, which extended from the floor of the fourth ventricle, emerged from the foramen of Magendie and descended to the C2 level. The patient was submitted to surgical treatment and during resection of the lesion, when near the vagal trigone, the patient presented great pressure lability. In the immediate postoperative period, the patient did not have a level of consciousness sufficient to tolerate extubation. Brain computed tomography (CT) was carried out, which showed multiple supratentorial hemorrhages. On the ninth day of the postoperative period, there was a sudden neurological worsening and anisocoria. A new brain CT was carried out [Figure 4], which demonstrated a diffuse cerebral edema. In spite of the introduction of clinical measures for the control of diffuse cerebral edema, the patient evolved to brain death.
  
  
  CONCLUSIONS
  The principal measures in the management of these cases include early diagnosis, detection of possible coagulation disorders, continual monitoring, and maintenance of adequate cerebral perfusion. Surgical treatment is recommended in cases of the presence of mass effect or diffuse edema not yielding to clinical treatment. High rates of mortality and morbidity are observed.
authors.affiliation: Department of Neurosurgery, Santa Casa de Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Lucas Alverne Freitas
authors.initials: LA
authors.lastname: de Albuquerque
authors.affiliation: Department of Neurosurgery, Santa Casa de Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Jules Carlos
authors.initials: JC
authors.lastname: Dourado
authors.affiliation: Department of Neurology and Neurosurgery, State University of Campinas, Campinas, São Paulo, Brazil.
authors.forename: João Paulo
authors.initials: JP
authors.lastname: Almeida
authors.affiliation: Department of Neurosurgery, Santa Casa de Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Bruno Silva
authors.initials: BS
authors.lastname: Costa
keywords: Ependymoma; hemorrhage; posterior fossa