Bilateral thalamic stroke after tonsillectomy in patient with collateral extracranial anastomosis : case report

2019
journal article
article
1
dc.abstract.enHaemorrhage remains the most frequent and serious complication of tonsillectomy. When bleeding is recurrent, gushing, and ceases spontaneously, pseudoaneurysm of the injured artery in the proximity of the tonsillar bed should be suspected. Haemorrhage related to pseudoaneurysm occurs most commonly in the first 30 days after surgery. It can sometimes be excessive and requires a revision procedure such as external carotid artery (ECA) ligation or embolisation. During those procedures, ECA should be checked for possible anastomoses, otherwise the bleeding may persist despite the intervention. We report an unusual case of a patient with recurrent post-tonsillectomy haemorrhage due to pseudoaneurysm of the facial artery, which persisted after ECA ligation because of the presence of collateral occipital-vertebral anastomosis. Due to the recurrence of bleeding episodes, endovascular treatment was implemented. However, the embolisation was complicated by bilateral thalamic stroke with unclear mechanism. This case highlights the importance of anastomosis between ECA and the vertebrobasilar system, both in recurrence of significant post-tonsillectomy bleeding and in potential thromboembolic complications. Therefore, ECA ligation should always be accompanied by exclusion of possible anastomoses. In cases of non-life-threatening bleeding, embolisation seems to be the proper and more selective therapy.pl
dc.contributor.authorMilnerowicz, Małgorzatapl
dc.contributor.authorGarcarek, Jerzypl
dc.contributor.authorBladowska, Joannapl
dc.contributor.authorMiś, Marcinpl
dc.contributor.authorMilnerowicz, Aleksandrapl
dc.contributor.authorSąsiadek, Marekpl
dc.date.accessioned2019-03-22T10:41:03Z
dc.date.available2019-03-22T10:41:03Z
dc.date.issued2019pl
dc.date.openaccess0
dc.description.accesstimew momencie opublikowania
dc.description.additionalBibliogr. s. e130pl
dc.description.physicale126-e130pl
dc.description.versionostateczna wersja wydawcy
dc.description.volume84pl
dc.identifier.doi10.5114/pjr.2019.83004pl
dc.identifier.eissn1899-0967pl
dc.identifier.issn1733-134Xpl
dc.identifier.projectROD UJ / OPpl
dc.identifier.urihttps://ruj.uj.edu.pl/xmlui/handle/item/71082
dc.languageengpl
dc.language.containerengpl
dc.rightsUdzielam licencji. Uznanie autorstwa - Użycie niekomercyjne - Bez utworów zależnych 4.0 Międzynarodowa*
dc.rights.licenceCC-BY-NC-ND
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/legalcode.pl*
dc.share.typeotwarte czasopismo
dc.subject.entonsillectomypl
dc.subject.enligationpl
dc.subject.entherapeutic embolisationpl
dc.subject.enpostoperative haemorrhagepl
dc.subtypeArticlepl
dc.titleBilateral thalamic stroke after tonsillectomy in patient with collateral extracranial anastomosis : case reportpl
dc.title.journalPolish Journal of Radiologypl
dc.typeJournalArticlepl
dspace.entity.typePublication
dc.abstract.enpl
Haemorrhage remains the most frequent and serious complication of tonsillectomy. When bleeding is recurrent, gushing, and ceases spontaneously, pseudoaneurysm of the injured artery in the proximity of the tonsillar bed should be suspected. Haemorrhage related to pseudoaneurysm occurs most commonly in the first 30 days after surgery. It can sometimes be excessive and requires a revision procedure such as external carotid artery (ECA) ligation or embolisation. During those procedures, ECA should be checked for possible anastomoses, otherwise the bleeding may persist despite the intervention. We report an unusual case of a patient with recurrent post-tonsillectomy haemorrhage due to pseudoaneurysm of the facial artery, which persisted after ECA ligation because of the presence of collateral occipital-vertebral anastomosis. Due to the recurrence of bleeding episodes, endovascular treatment was implemented. However, the embolisation was complicated by bilateral thalamic stroke with unclear mechanism. This case highlights the importance of anastomosis between ECA and the vertebrobasilar system, both in recurrence of significant post-tonsillectomy bleeding and in potential thromboembolic complications. Therefore, ECA ligation should always be accompanied by exclusion of possible anastomoses. In cases of non-life-threatening bleeding, embolisation seems to be the proper and more selective therapy.
dc.contributor.authorpl
Milnerowicz, Małgorzata
dc.contributor.authorpl
Garcarek, Jerzy
dc.contributor.authorpl
Bladowska, Joanna
dc.contributor.authorpl
Miś, Marcin
dc.contributor.authorpl
Milnerowicz, Aleksandra
dc.contributor.authorpl
Sąsiadek, Marek
dc.date.accessioned
2019-03-22T10:41:03Z
dc.date.available
2019-03-22T10:41:03Z
dc.date.issuedpl
2019
dc.date.openaccess
0
dc.description.accesstime
w momencie opublikowania
dc.description.additionalpl
Bibliogr. s. e130
dc.description.physicalpl
e126-e130
dc.description.version
ostateczna wersja wydawcy
dc.description.volumepl
84
dc.identifier.doipl
10.5114/pjr.2019.83004
dc.identifier.eissnpl
1899-0967
dc.identifier.issnpl
1733-134X
dc.identifier.projectpl
ROD UJ / OP
dc.identifier.uri
https://ruj.uj.edu.pl/xmlui/handle/item/71082
dc.languagepl
eng
dc.language.containerpl
eng
dc.rights*
Udzielam licencji. Uznanie autorstwa - Użycie niekomercyjne - Bez utworów zależnych 4.0 Międzynarodowa
dc.rights.licence
CC-BY-NC-ND
dc.rights.uri*
http://creativecommons.org/licenses/by-nc-nd/4.0/legalcode.pl
dc.share.type
otwarte czasopismo
dc.subject.enpl
tonsillectomy
dc.subject.enpl
ligation
dc.subject.enpl
therapeutic embolisation
dc.subject.enpl
postoperative haemorrhage
dc.subtypepl
Article
dc.titlepl
Bilateral thalamic stroke after tonsillectomy in patient with collateral extracranial anastomosis : case report
dc.title.journalpl
Polish Journal of Radiology
dc.typepl
JournalArticle
dspace.entity.type
Publication
Affiliations

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