Supratentorial Intraparenchymal Haemorrhages during Spine Surgery
A 28-year-old woman presented with an acute onset of bilateral lower weakness. She had a history of Ewing's sarcoma involving the thoracic spine with metastases to the right lung, right kidney and brain (). Palliative systemic chemotherapy, radiotherapy to the right thorax, and whole brain irradiation were given seven months prior. She had no bleeding diathesis. On examination, she did not have any sign of raised intracranial pressure (ICP). Her lower limb motor power was grade 1/5 bilaterally. The sensory level was at T10 dermatome. There was acute urinary retention but intact anal tone. Computerized tomography (CT) of the brain showed multiple cerebral and cerebellar metastases with perifocal oedema (). There was no hydrocephalus. Magnetic resonance studies showed an intradural extramedullary lesion at T4/5 that was causing significant cord compression ().\nBecause of previous radiotherapy, surgery was the only treatment option for her. Laminectomy for tumour excision was therefore performed. Intra-operatively, spinal CSF was drained under normal pressure. Her haemodynamics were stable during surgery. The spinal cord was well decompressed after tumour removal. The procedure lasted three hours and 15 minutes. Immediately after surgery, the patient was found to have dilated and non-reactive pupils. CT brain scan showed significant brain swelling and multiple ICHs (). Her family declined further surgery in view of the poor prognosis. She died two days later despite medical therapy. Histological examination of the spinal lesion showed metastatic Ewing's sarcoma. No autopsy was performed.