A case of intracerebral hemorrhage after a microsurgical bypass is presented in detail. Thirteen other cases from different centers are summarized briefly. Nine of the patients had had a stroke that resulted in a persistent neurological deficit within the 10 weeks before operation. None of the patients, however, had a severe neurological deficit preoperatively. Ten patients either died or remained hemiplegic and comatose or aphasic as a consequence of the intracerebral hemorrhage. Deterioration was noted immediately after operation in two cases and several hours to 10 days after operation in the rest. Eight of the hemorrhages were large, deep intracerebral or cerebellar hemorrhages. The other hemorrhages either were more peripherally located or resembled hemorrhagic infarction. In some of the latter cases a recent pale infarct may have been converted into a hemorrhagic infarct by revascularization. Also, it is possible that some of the cases of hemorrhagic infarction were due to postoperative embolism from the distal lumen of an occluded internal carotid artery. Almost all of the patients were hypertensive preoperatively, and most experienced a period of significant elevation of the systemic blood pressure postoperatively before neurological deterioration. We strongly recommend careful and constant control of the blood pressure during the postoperative period in all patients undergoing bypass procedures, but particularly in patients known to be hypertensive or to have had a recent stroke.
ASJC Scopus subject areas
- Clinical Neurology