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Postoperative cerebral hemorrhage death in a patient with secondary hyperparathyroidism: a report of one case and literature review

Secondary Hyperparathyroidism (SHPT) is a common complication of end-stage renal disease (ESRD), and parathyroid surgery (PTX) is an effective way to treat patients with severe SHPT. ESRD has multiple associations with cerebrovascular diseases. For example, the incidence of stroke in patients with E...

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Autores principales: Zhou, Peng, Xu, Jing, Zhuang, Dayong, Li, Xiaolei, Yue, Tao, Hu, Huaiqiang, He, Qingqing
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10213765/
https://www.ncbi.nlm.nih.gov/pubmed/37250421
http://dx.doi.org/10.3389/fnins.2023.1153453
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author Zhou, Peng
Xu, Jing
Zhuang, Dayong
Li, Xiaolei
Yue, Tao
Hu, Huaiqiang
He, Qingqing
author_facet Zhou, Peng
Xu, Jing
Zhuang, Dayong
Li, Xiaolei
Yue, Tao
Hu, Huaiqiang
He, Qingqing
author_sort Zhou, Peng
collection PubMed
description Secondary Hyperparathyroidism (SHPT) is a common complication of end-stage renal disease (ESRD), and parathyroid surgery (PTX) is an effective way to treat patients with severe SHPT. ESRD has multiple associations with cerebrovascular diseases. For example, the incidence of stroke in patients with ESRD is 10 times higher than that in the general population, the risk of death after acute stroke is three times higher, and the risk of hemorrhagic stroke is significantly higher. High/low serum calcium, high PTH, low serum sodium, high white blood cell count, previous occurrences of cerebrovascular events, polycystic kidney disease (as a primary disease), and the use of anticoagulants are independent risk factors for hemorrhagic stroke in hemodialysis patients with uremia. The risk of stroke in patients who undergo PTX decreases significantly in the second year of follow-up and persist thereafter. However, studies on the risk of perioperative stroke in SHPT patients are limited. After undergoing PTX, the PTH levels in SHPT patients drop suddenly, they undergo physiological changes, bone mineralization increases, and calcium in the blood gets redistributed, often accompanied by severe hypocalcemia. Serum calcium might influence the occurrence and development of hemorrhagic stroke at various stages. To prevent bleeding from the operated area, the use of anticoagulants after surgery is reduced in some cases, which often decreases the frequency of dialysis and increases the quantity of fluid in the body. An increase in the variation in blood pressure, instability of cerebral perfusion, and extensive intracranial calcification during dialysis promote hemorrhagic stroke, but these clinical problems have not received enough attention. In this study, we reported the death of an SHPT patient who suffered a perioperative intracerebral hemorrhage. Based on this case, we discussed the high-risk factors for perioperative hemorrhagic stroke in patients who undergo PTX. Our findings might help in the identification and early prevention of the risk of profuse bleeding in patients and provide reference for the safe performance of such operations.
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spelling pubmed-102137652023-05-27 Postoperative cerebral hemorrhage death in a patient with secondary hyperparathyroidism: a report of one case and literature review Zhou, Peng Xu, Jing Zhuang, Dayong Li, Xiaolei Yue, Tao Hu, Huaiqiang He, Qingqing Front Neurosci Neuroscience Secondary Hyperparathyroidism (SHPT) is a common complication of end-stage renal disease (ESRD), and parathyroid surgery (PTX) is an effective way to treat patients with severe SHPT. ESRD has multiple associations with cerebrovascular diseases. For example, the incidence of stroke in patients with ESRD is 10 times higher than that in the general population, the risk of death after acute stroke is three times higher, and the risk of hemorrhagic stroke is significantly higher. High/low serum calcium, high PTH, low serum sodium, high white blood cell count, previous occurrences of cerebrovascular events, polycystic kidney disease (as a primary disease), and the use of anticoagulants are independent risk factors for hemorrhagic stroke in hemodialysis patients with uremia. The risk of stroke in patients who undergo PTX decreases significantly in the second year of follow-up and persist thereafter. However, studies on the risk of perioperative stroke in SHPT patients are limited. After undergoing PTX, the PTH levels in SHPT patients drop suddenly, they undergo physiological changes, bone mineralization increases, and calcium in the blood gets redistributed, often accompanied by severe hypocalcemia. Serum calcium might influence the occurrence and development of hemorrhagic stroke at various stages. To prevent bleeding from the operated area, the use of anticoagulants after surgery is reduced in some cases, which often decreases the frequency of dialysis and increases the quantity of fluid in the body. An increase in the variation in blood pressure, instability of cerebral perfusion, and extensive intracranial calcification during dialysis promote hemorrhagic stroke, but these clinical problems have not received enough attention. In this study, we reported the death of an SHPT patient who suffered a perioperative intracerebral hemorrhage. Based on this case, we discussed the high-risk factors for perioperative hemorrhagic stroke in patients who undergo PTX. Our findings might help in the identification and early prevention of the risk of profuse bleeding in patients and provide reference for the safe performance of such operations. Frontiers Media S.A. 2023-05-11 /pmc/articles/PMC10213765/ /pubmed/37250421 http://dx.doi.org/10.3389/fnins.2023.1153453 Text en Copyright © 2023 Zhou, Xu, Zhuang, Li, Yue, Hu and He. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neuroscience
Zhou, Peng
Xu, Jing
Zhuang, Dayong
Li, Xiaolei
Yue, Tao
Hu, Huaiqiang
He, Qingqing
Postoperative cerebral hemorrhage death in a patient with secondary hyperparathyroidism: a report of one case and literature review
title Postoperative cerebral hemorrhage death in a patient with secondary hyperparathyroidism: a report of one case and literature review
title_full Postoperative cerebral hemorrhage death in a patient with secondary hyperparathyroidism: a report of one case and literature review
title_fullStr Postoperative cerebral hemorrhage death in a patient with secondary hyperparathyroidism: a report of one case and literature review
title_full_unstemmed Postoperative cerebral hemorrhage death in a patient with secondary hyperparathyroidism: a report of one case and literature review
title_short Postoperative cerebral hemorrhage death in a patient with secondary hyperparathyroidism: a report of one case and literature review
title_sort postoperative cerebral hemorrhage death in a patient with secondary hyperparathyroidism: a report of one case and literature review
topic Neuroscience
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10213765/
https://www.ncbi.nlm.nih.gov/pubmed/37250421
http://dx.doi.org/10.3389/fnins.2023.1153453
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