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Retroperitoneal hematoma is an uncommon clinical entity that may be encountered more frequently as iatrogenic injuries occur during interventional procedures. This chapter presents a case study of a 71-year-old male who presented to the emergency room with new onset headache, stiff neck, and slight confusion. The clinical manifestations of retroperitoneal hematoma are vague and thus the clinician must have a high index of suspicion to make the diagnosis. If the hematoma develops near or within the iliopsoas muscle, patients will present with a femoral neuropathy. Diagnosis of retroperitoneal hematoma is made either via computed tomography (CT) or angiography. However, if the patient is unstable or has ongoing bleeding, endovascular therapy with stent-grafting across the injured vessel is a treatment option if interventional radiology is available. Surgery may also be indicated to decompress the retroperitoneal space if nerve or ureteral compression exists.
Normal perfusion pressure breakthrough is a potentially catastrophic event after arteriovenous malformation (AVM) surgery. Anesthesia providers should strive for tight perioperative blood pressure control and should be vigilant for signs of postoperative neurologic deterioration. This chapter presents a case study of a 37-year-old female with a 2-month history of generalized tonic-clonic seizures. The patient underwent a successful left craniotomy for clipping and resection of an AVM located in the left parietooccipital lobe. Emergent computed tomography (CT) scan of the brain showed massive cerebral edema, as well as enlarged vascular enhancement suggesting hyperperfusion and a small intracerebral hemorrhage. One month after surgery, examination demonstrated no neurologic deficit and a cerebral angiography showed normalization of flows and diameter of the left posterior cerebral artery. Neuroimaging evidence of normal pattern of cerebral vasoreactivity along with neurologic status improvement may warrant barbiturate withdrawal and careful liberalization of the blood pressure control.
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