Iatrogenic Posterior Fossa Epidural Hematoma After Therapeutic Cerebral Venogram

Proposal Number:


Proposal Type:

Medically Challenging Case Report Poster 


Alvin Tsang  
Mayo Clinic


Arnoley Abcejo  
Mayo Clinic


Learning Objectives
1. Understand the perioperative complications of "simple" outpatient cerebrovascular interventional procedures.
2. Identify the acute and hyperacute signs of impending posterior fossa herniation due to iatrogenic epidural hematoma.
3. Review the anesthetic management of impending intracranial pressure catastrophe.

A 52-year-old female with history of idiopathic intracranial hypertension, chronic obstructive pulmonary disease, hypertension, seizures, morbid obesity status post gastric bypass, and obstructive sleep apnea presented for cerebral venogram with stenting of the right transverse sigmoid sinus junction under general anesthesia by patient request. After an uneventful procedure, extubation and arrival to the recovery unit, the patient complained of headache followed consecutively by altered mental status, desaturation, apnea, and unresponsiveness refractory to naloxone. A new junctional rhythm was noted on telemetry associated with progressive hypotension. Neurologic exam worsened with new dysconjugate gaze. She was emergently intubated and initiated on a phenylephrine infusion. Emergent head CT revealed an acute epidural hematoma in the left posterior fossa with obstructing hydrocephalus, tonsillar herniation, and ascending herniation through the tentorium. She subsequently had an emergent craniectomy with successful evacuation of the hematoma confirmed with CT. She was extubated and following commands the following day.

Professional Category:




Supporting Image: epiduralhematomapga.jpg
   ·Posterior Fossa Epidural Hematoma
Supporting Image: obstructinghydrocephaluspga.jpg
   ·Temporal Horn Dilation from Obstructing Hydrocephalus

Enter up to two references.

1. Alakbarzade V, Pereira AC Cerebral catheter angiography and its complications Practical Neurology 2018;18:393-398.
2. Kaufmann, T. J., Huston, J., Mandrekar, J. N., Schleck, C. D., Thielen, K. R., & Kallmes, D. F. (2007). Complications of Diagnostic Cerebral Angiography: Evaluation of 19 826 Consecutive Patients1. Radiology, 243(3), 812-819. doi:10.1148/radiol.2433060536