Remote intracerebral hemorrhage following craniotomy for an intracerebral hematoma: A case report

Abstract

Remote intracerebral hemorrhage (RICH) is a rare yet highly consequential complication that can occur after a craniotomy performed for the evacuation of an intracerebral hemorrhage (ICH). In this case report, we present the clinical details of a 74-year-old female patient who underwent a supratentorial craniotomy to address an ICH, and subsequently developed RICH. A 74-year-old woman was admitted to our department with a severe headache, onset of dysarthria, and left-sided brachio-crural hemiparesis. The patient had a history of arterial hypertension and a previous cerebral ischemia incident 2 years prior, potentially due to cerebral amyloid angiopathy. Despite the immediate surgical intervention and intensive care, she succumbed to respiratory distress after developing a contralateral ICH. RICH following craniotomy for an intracerebral hematoma is a rare but potentially devastating complication. Close monitoring, prompt recognition of neurological deterioration, and timely intervention are imperative to optimize patient outcomes. Further research is needed to better understand the underlying mechanisms and risk factors associated with this complication, allowing for improved prevention and management strategies in the future.

Keywords: amyloid angiopathy; arterial hypertension; craniotomy; intracerebral hematoma; remote intracerebral hemorrhage.

FIGURE 1

Brain MRI axial images in series demonstrating the characteristic microbleeds associated with cerebral amyloid angiopathy in the T2‐weighted gradient echo sequences. Cerebral microhemorrhages, defined as 2–10 mm, round, or ovoid areas of hemorrhage, tend to be cortico‐subcortical (at the gray‐white matter junction) and spare the basal ganglia and pons, in contrast to hypertensive microhemorrhages.

FIGURE 2

Preoperative brain CT axial (A), sagittal (B), and coronal (C) images show an extensive intracerebral hemorrhage in the right temporo‐parietal region, causing a significant mass effect and a leftward shift of median structures by 10 mm. An early right uncal herniation was also documented.

FIGURE 3

6‐h postoperative brain CT axial (A), sagittal (B), and coronal (C) images show the presence of a contralateral intracerebral hemorrhage in the left parietal region, measuring approximately 50 mm, without shift of median structures.

FIGURE 4

24‐h postoperative brain CT axial (A), sagittal (B), and coronal (C) images revealed an additional extension of the contralateral intracerebral hematoma.