====== 🩸 Hemorrhagic Complication ======

===== 📌 Definition =====
A **hemorrhagic complication** is any **unexpected or excessive bleeding event** occurring as a direct or indirect result of a medical or surgical intervention. These complications can be **intraoperative** or **postoperative**, and may range from minor to life-threatening.

===== 🧠 Relevance in Neurosurgery =====
In cranial or spinal procedures, hemorrhagic complications may lead to:
  * Neurological deterioration
  * Increased intracranial pressure
  * Need for urgent reoperation
  * Prolonged hospitalization or death

===== 🧩 Classification =====

^ Type ^ Description ^ Examples ^
| **Intraoperative bleeding** | Occurs during surgery, may require transfusion or hemostatic agents | Venous sinus injury, arterial rupture |
| **Postoperative bleeding** | Bleeding after wound closure; may cause hematoma or reoperation | Epidural hematoma, tumor bed hemorrhage |
| **Remote hemorrhage** | Bleeding at site distant from surgery, often due to pressure shifts or CSF loss | Contralateral cerebellar hemorrhage |
| **Rebleeding** | New bleeding at a previously stable site | After aneurysm clipping or tumor resection |
| **Microscopic (occult)** | Not clinically obvious but detected via imaging or labs | Radiological hematoma, drop in hemoglobin |

===== 🧪 Risk Factors =====
  * Coagulopathy (INR >1.5, platelets <100,000/µL)
  * Use of antiplatelets, anticoagulants, NSAIDs
  * Hypertension (perioperative)
  * Inadequate hemostasis
  * Intraoperative CSF overdrainage
  * Infection or poor wound healing

===== 🖼️ Diagnosis =====
  * **Clinical signs**: wound swelling, decreased consciousness, focal neurological deficits, seizures
  * **Imaging**:
    - CT: epidural, subdural, intracerebral bleeding
    - MRI: more sensitive in subacute/chronic stages
  * **Laboratory tests**: hemoglobin, platelet count, INR, aPTT

===== 🛠️ Management =====
  * Immediate CT scan if neurological changes occur
  * ICU monitoring and neurological observation
  * Surgical evacuation if mass effect or deterioration:
    - Craniotomy, burr-hole, or decompressive surgery
  * Hemostatic support:
    - Platelet transfusion
    - Vitamin K or prothrombin complex concentrate (PCC)
    - Desmopressin (in platelet dysfunction)
  * Blood pressure control and reversal of anticoagulants

===== ⚠️ Examples in Neurosurgery =====

^ Type ^ Description ^
| **Post-craniotomy epidural hematoma** | Rapidly expanding, can compress brain tissue; surgical emergency |
| **Post-tumor resection cavity bleed** | May lead to swelling, midline shift |
| **Delayed subdural hematoma** | Often in elderly or anticoagulated patients; can be subacute or chronic |
| **Hemorrhage after biopsy** | Particularly in vascular lesions (e.g., high-grade gliomas) |

===== 📋 Prevention =====
  * Preoperative correction of coagulopathy
  * Avoid NSAIDs or antiplatelets perioperatively if high risk
  * Careful intraoperative hemostasis
  * Postoperative imaging in high-risk patients
  * Gradual CSF drainage if applicable

===== 📌 Summary =====
A **hemorrhagic complication** is a serious postoperative event that must be promptly recognized and managed. In neurosurgery, even small-volume bleeding can have severe consequences. Vigilant monitoring, early imaging, and rapid intervention are key to improving outcomes.