A possible lifesaving case of severe pulmonary embolism after neuroendoscopic hematoma removal

Abstract

A 56-year-old female without any medical history was admitted to our hospital for impaired consciousness and right-sided hemiplegia. A head CT showed left putaminal hemorrhage. Conservative medical therapy was performed. However, hematoma was expanded. Endoscopic hematoma removal was done under general anesthesia for symptom improvement. Clinical condition about the speech was improved. However, severe right-sided hemiplegia remained. The patient used compression stocking and intermittent pneumatic compression for the prevention of thrombosis after the operation. She scheduled changing the hospital for continuing rehabilitation. Sudden hypotension and oxygen desaturation occurred 7–8 days after the operation. Plasma d-dimer level elevated sharply. Deep venous thrombosis in the right-sided popliteal vein was identified by ultrasonography. We reached a diagnosis as a severe pulmonary embolism. A huge blood clot in right atrium was identified and attached to tricuspid valve by transthoracic echocardiography. Emergency thrombectomy was performed in a thoracotomy and her life was saved. Pulmonary embolism is a remarkable complication in stroke. We have to pay attention not only preventing the onset but also early diagnosis and starting rapid therapy for patient’s survival.