title: A rare case of symmetrical four limb gangrene following emergency neurosurgery.
abstract: BACKGROUND
  The authors report a case of symmetrical peripheral gangrene (SPG) following emergency neurosurgery.
  
  
  METHODS
  A 35-year-old female presented to hospital in Thailand with nausea, headache, and subsequent seizures. She was found to have a large intracranial space-occupying lesion with mass effect. Following emergency surgical debulking and decompression, she suffered from severe sepsis with multiple organ failure, treated with high dose intravenous vasopressors and developed secondary gangrene in all four limbs. She was repatriated to the UK with a baseline GCS of 8 and multiple postoperative medical complications. With initial conservative management, the patient made a prolonged but satisfactory progression to recovery prior to semi-elective debridement and selected digit amputation of the gangrene.
  
  
  CONCLUSIONS
  This is the first reported case of four limb symmetrical peripheral gangrene following an emergency craniotomy.
  
  
  CONCLUSIONS
  Although rare, SPG is a substantial complication with high mortality and morbidity and therefore should be especially taken into account for emergency intracranial pathologies in neurosurgical patients, particularly if they require emergency surgery.
authors.affiliation: University of Warwick Medical School, Gibbet Hill Road, Coventry, West Midlands CV4 7AL, United Kingdom. Electronic address: vivian.phan@hotmail.com.
authors.forename: Pho Nh
authors.initials: PN
authors.lastname: Phan
authors.affiliation: Department of Neurosurgery, University Hospital of Coventry and Warwickshire, Clifford Bridge Road, Coventry, West Midlands CV2 2DX, United Kingdom. Electronic address: vikas.acharya@doctors.org.uk.
authors.forename: Vikas
authors.initials: V
authors.lastname: Acharya
authors.affiliation: Department of Neurosurgery, University Hospital of Coventry and Warwickshire, Clifford Bridge Road, Coventry, West Midlands CV2 2DX, United Kingdom. Electronic address: dhruv.parikh@uhcw.nhs.uk.
authors.forename: Dhruv
authors.initials: D
authors.lastname: Parikh
authors.affiliation: Department of Neurosurgery, University Hospital of Coventry and Warwickshire, Clifford Bridge Road, Coventry, West Midlands CV2 2DX, United Kingdom. Electronic address: amjad.shad@uhcw.nhs.uk.
authors.forename: Amjad
authors.initials: A
authors.lastname: Shad
keywords: Ischaemia; Neurosurgery; Postoperative complications; Septicaemia; Symmetrical peripheral gangrene