Xxiv международная медико-биологическая конференция молодых исследователей Фундаментальная наука и клиническая

Medical history.
A 50-year-old male patient was admitted to 
the department of neurosurgery for residual bilateral frontoparietal 

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5
TH
ISP SYMPOSIUM ON CLINICAL PATHOPHYSIOLOGY
951
meningioma surgery. The patient underwent two craniotomies, one in 
2008 and one in 2011. After the second craniotomy, a cranioplasty was 
also performed. The patient had regular neuroradiological follow-ups. 
In 2020, during another regular neuroradiological follow-up, a residual 
meningioma was noticed, and another neurosurgery was scheduled. 
Bilateral frontoparietal craniotomy with tumor reduction followed by 
cranioplasty was done. Two days later, due to postoperative complications, 
revision surgery was performed, leaving a skull defect open. The patient 
was transferred to the ICU where he was intubated. In the postoperative 
period, he was afebrile and hemodynamically stable. His neurological 
status was normal with a ten-days mean GCS 9. On a postoperative day 11, 
a weakness in the muscles of the right side of the body was detected which 
persisted in the following two days. On a postoperative day 14, the patient 
was afebrile, hemodynamically stable with a normalized neurological 
status and GCS 11 (E4/V1/M6). Extubation was done and physical therapy 
was planned. After the extubation, the patient had GCS 11 (E3/V2/M6). 
60 minutes after the extubation, the patient underwent physical therapy. 
He was positioned upright while sitting with his legs hanging down when 
bradycardia (37 bpm), followed by a rapid neurological decline occurred. 
His GCS went from 11 to 9(E2/V2/M5). A brain CT scan was indicated. 
The CT scan showed significant compression of bifrontal underlying dura 
and brain tissue as well as compression of the frontal ventricular system. 
Obliteration of subarachnoid space was also noticed. No visible cerebral 
herniation was detected. There were also no signs of acute ischemia or 
hemorrhage. Due to deteriorating neurological status, the patient was 
intubated again. To prevent further neurological worsening, he was 
frequently placed in the Trendelenburg position.
His overall clinical condition promptly stabilized and no further 
decline in neurological status was noticed. In the next two days, he was 
continually put in Trendelenburg’s position and his neurological status 
improved with his GCS reaching 11 (E4/V1/M6). The control CT scan 
showed improvement.