Ana M Velez1, William A Friedman. 1. Department of Neurological Surgery, University of Florida, Gainesville, Florida 32610, USA.
Abstract
BACKGROUND AND IMPORTANCE: Disseminated intravascular coagulation is a relatively common complication in patients with trauma, sepsis, obstetric calamities, and certain malignancies. We report a rare case of DIC after embolization and surgery for a large meningioma. We also review the literature on coagulopathy during brain tumor surgery as well as the diagnosis and treatment of this complication. CLINICAL PRESENTATION: A 62-year-old woman presented with a 3-week history of aphasia, difficulty with handwriting, personality change, and right-sided weakness. Magnetic resonance imaging demonstrated a 6.3 × 5.4-cm multilobe and avidly enhancing mass within the left frontal region. The patient underwent preoperative transcatheter Onyx embolization of the tumor, followed immediately by craniotomy for resection of the tumor. Surgery was complicated by coagulopathy leading to substantial blood loss. The diagnosis of disseminated intravascular coagulation was established by intraoperative thromboelastography, after which the patient was treated with replacement therapy, Amicar, and modest hypotension. One year after surgery, the patient had fully recovered and had no focal neurological deficit. CONCLUSION: This case report adds to the few reported cases of disseminated intravascular coagulation as a complication of brain tumor surgery. This patient's successful outcome may be attributed to timely recognition of the condition and effective, prompt treatment.
BACKGROUND AND IMPORTANCE: Disseminated intravascular coagulation is a relatively common complication in patients with trauma, sepsis, obstetric calamities, and certain malignancies. We report a rare case of DIC after embolization and surgery for a large meningioma. We also review the literature on coagulopathy during brain tumor surgery as well as the diagnosis and treatment of this complication. CLINICAL PRESENTATION: A 62-year-old woman presented with a 3-week history of aphasia, difficulty with handwriting, personality change, and right-sided weakness. Magnetic resonance imaging demonstrated a 6.3 × 5.4-cm multilobe and avidly enhancing mass within the left frontal region. The patient underwent preoperative transcatheter Onyx embolization of the tumor, followed immediately by craniotomy for resection of the tumor. Surgery was complicated by coagulopathy leading to substantial blood loss. The diagnosis of disseminated intravascular coagulation was established by intraoperative thromboelastography, after which the patient was treated with replacement therapy, Amicar, and modest hypotension. One year after surgery, the patient had fully recovered and had no focal neurological deficit. CONCLUSION: This case report adds to the few reported cases of disseminated intravascular coagulation as a complication of brain tumor surgery. This patient's successful outcome may be attributed to timely recognition of the condition and effective, prompt treatment.
Authors: Matthew R Fusco; Mohamed M Salem; Bradley A Gross; Arra S Reddy; Christopher S Ogilvy; Ekkehard M Kasper; Ajith J Thomas Journal: J Cerebrovasc Endovasc Neurosurg Date: 2016-03-31