INTRACRANIAL HEMORRHAGE AND HEMATOMA FOLLOWING OPEN HEART SURGERY

This paper presents an analysis of 20 cases of intracranial hemorrhage and hematoma following open heart surgery; 18 of them were found during exploratory craniotomy and 2 at autopsy. Their clinical manifestations immediately after operation can be classified into 3 groups: comatose, semi-conscious and mentally clear. Of the hematomas, 85% were located either epidurally or subdurally or both, 10% in the brain and 5% in the subarachnoid space. Their geographic distribution showed a greater proportion in the frontal region when a single area was involved and in the temporal and parietal regions when the hematoma occupied multiple areas. The sources of bleeding in most cases appeared to be of venous orlgin and in only one case was tearing of a small artery seen. The results oi the expforatory craniotomy showed 10 survivals and 8 deaths. None in the comatose group survived. The authors attribute the pathogenesis of this neurological complication to multiple factors including: intraoperative anticoagulation, hypertonic perfusion, excessive postoperative diuresis and head trauma sustained preoperatively, intraoperatively or postoperatively. They stress early diagnosis and early exploratory craniotomy once the lateralizing signs appear.