A Report of Simultaneous Complications of Ischemic Stroke and Intracerebral Hemorrhage in Geriatric Patients Undergoing Craniotomy for Tumor Resections during the Perioperative Period
Objective To observe the clinical characteristics of geriatric patients who underwent craniotomy for tumor resections and simultaneously complicated with ischemic stroke and intracerebral hemorrhage during the perioperative period,and to provide a reference on perioperative anesthesia management of geriatric patients who underwent craniotomy for tumor resections.Methods The data of patients over 65 years old who underwent craniotomy for tumor resections were continuously collected in Beijing Tiantan Hospital,Capital Medical University from January 2018 to October 2020,and the general data,clinical data,and imaging characteristics of patients simultaneously complicated with perioperative ischemic stroke and intracerebral hemorrhage were summarized.Results A total of 6 geriatric patients had perioperative ischemic stroke combined with intracerebral hemorrhage during the study period,aged from 65 to 72 years,3 cases(50％)of males and 3 cases(50％)of females.Among them,5(83％)patients had malignant tumors,4(67％)had glioblastoma,and 5(83％)patients had tumors with a maximum diameter of ≥40 mm.Five(83％)patients had hypertension,2(33％)patients had ischemic cerebrovascular disease,and 2(33％)patients had diabetes mellitus.Two(33％)patients occurred hypotension intraoperatively.All postoperative ischemic stroke detected was a cryptogenic stroke,2(33％)patients had an ischemic stroke before intracerebral hemorrhage,3(50％)patients had intracerebral hemorrhage within 48 h after surgery,and 1(17％)patient had ischemic stroke again after hematoma removal,with a large cerebral infarction.One(17％)patient was discharged automatically with an NIHSS score of 25 and a deep coma.At the time of discharge,2(33％)patients had an NIHSS score of 1,and the remaining 3(50％)patients had an NIHSS score of 0.Conclusions Geriatric patients undergoing craniotomy for tumor resections complicated with ischemic stroke and intracerebral hemorrhage during the perioperative period have poor prognosis,and most of them have a history of hypertension.Most of the ischemic stroke found in this study was cryptogenic stroke,suggesting that geriatric patients should pay attention to the observation of mild or suspicious symptoms of perioperative stroke and timely diagnosis and treatment.
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