RESUMO
Raised Intra-Cranial Pressure causes hypertension. We report a 75 years old lady with large Middle Cerebral Artery bifurcation aneurysm that was operated on. Post-operatively she had a progressive hypotension that was refractory to inotropes and became life threatening. There was subgaleal, extradural and subdural collection of Cerebro-Spinal Fluid. Drainage of this collection led to immediate complete recovery from hypotension, normalization of tachycardia and improvement in sensorium within 4 hours. Raised Intra-Cranial Pressure can manifest with hypotension and tachycardia if the right insula has been exposed. Removal of the irritant can lead to rapid and complete recovery.
RESUMO
INTRODUCTION: This is an original case series on soldiers evacuated from HAA(High Altitude Area) over last one year(Sept 2017-Aug 2018), of which 100% cases were found to have gastric antrum perforation. This is a deviation from the usual trend that is being noted in Indian subcontinent where duodenal perforations are commonest. DISCUSSION: High altitude associated dyspepsia is a common phenomenon and some studies done in high altitude population have recorded high incidence of antral gastritis and mucosal atrophy on histo-pathological evaluation. This is also supported by high incidence of H. pylori infection. The presence of atrophic gastric mucosa associated with antral gastritis, when exposed to hypobaric hypoxemic conditions faced by soldiers posted to heights above 15,000 ft, may leads to increased intra-luminal pressure and ischemia which probably predisposes individuals for gastric antrum perforations. CONCLUSION: This is a relatively untouched topic as we have not found studies onhigh altitude related gastric perforations and probably this is the first case series of its kind. The acknowledgement of this phenomenon may pave way for further studies for defining the role of high altitude in gastric perforations.
