Massive intracerebral hemorrhage.

01. Today's Case(Operation: neurosurgery). 2018/03/25
Intracerebral hemorrhage. female, 47 year.
Massive lesion, ICP elevation, Both eyes: fixed and dilated
pupils. Left side slightly responds. Post-op: no pupil reflex
returns. close to Brain death.  

Etiology: She has arrythmia. something like a Pacemaker has been
implanted in the chest wall subcutaneously. (visible) but not in the
axillary / subclavicle region. She has been taking anti-coagulant,
LMWH. 

Operation: parieto-temporal incision. open dura. aspirate blood and
uncus to save brain-stem. microscopic surgery. 




Microscopic Surgery.


fixed and dilated pupil indicates the brain stem is
compressed. trans-tentorial herniation by uncus is dangerous because
it compresses brain stem. 

According to the surgeon, both eyes are dilated and fixed, the rate of
survival is less than 5%.