title: Disseminated Intravascular Coagulation in Secondary Glioblastoma due to Excessive Intraoperative Bleeding: Case Report and Review of the Literature.
abstract: BACKGROUND
  Disseminated intravascular coagulation (DIC) describes a pathologic activation of coagulation mechanisms, leading to thrombi in various organs with contribution to multiple organ failure. In clinical practice, diagnosis of DIC can often be made by laboratory values, including prolonged coagulation times, thrombocytopenia, or high levels of fibrin degradation products. DIC is frequently observed after neurotrauma, but rarely occurs in patients with primary brain tumors. There are only few case reports of DIC in patients with primary brain tumors, all sharing the highly elevated mortality. We report the case of a young patient presenting with secondary glioblastoma, who developed multiorgan failure induced by DIC after extensive intraoperative bleeding.
  
  
  METHODS
  A 30-year-old patient was admitted in poor general condition with insomnia, severe headache, and vomiting. She had undergone surgery for secondary glioblastoma twice. Magnetic resonance imaging revealed a left temporoparietal mass lesion with indication for resection. Surgery then was complicated by diffuse intraoperative bleeding due to a high content of microvascular proliferation as shown in the histopathologic workup. Subsequently, an uncontrollable multiorgan failure developed, causing the patient's death 4 days after surgery.
  
  
  CONCLUSIONS
  Although a rare complication, excessive intraoperative bleeding, especially in surgery for brain tumors located next to the ventricular system, DIC should be kept in mind as a possible diagnosis.
authors.affiliation: Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Daniel
authors.initials: D
authors.lastname: Pinggera
authors.affiliation: Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Johannes
authors.initials: J
authors.lastname: Kerschbaumer
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Nicole
authors.initials: N
authors.lastname: Innerhofer
authors.affiliation: Institute of Neurology, Medical University of Vienna, Vienna, Austria.
authors.forename: Adelheid
authors.initials: A
authors.lastname: Woehrer
authors.affiliation: Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria. Electronic address: christian.freyschlag@tirol-kliniken.at.
authors.forename: Christian Franz
authors.initials: CF
authors.lastname: Freyschlag
authors.affiliation: Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Claudius
authors.initials: C
authors.lastname: Thomé
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D001932:Brain Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology*; D003937:Diagnosis, Differential; D004211:Disseminated Intravascular Coagulation / Q000000981:diagnostic imaging* / Q000209:etiology*; D005260:Female; D005909:Glioblastoma / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D009102:Multiple Organ Failure / Q000000981:diagnostic imaging / Q000209:etiology; D016609:Neoplasms, Second Primary / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D019635:Neurosurgical Procedures / Q000009:adverse effects*
keywords: Bleeding; Disseminated intravascular coagulation; Glioblastoma