Perioperative anesthetic management on burr hole drainage of subdural hematoma during thyroid storm in a patient with down syndrome: Case report

Subdural hematoma (SDH) is an intracranial lesion formed by the accumulation of blood in the space between arachnoid and duramater due to a tear of the vein or artery between duramater and arachnoid. SDH is caused by trauma, vascular malformations, coagulopathies, neoplasms, or in rare cases such as hyperthyroidism that can increase intracranial pressure that lead to life-threatening. A thyroid storm represents an endocrine emergency marked by thyrotoxicosis and can be triggered by trauma and severe stress conditions such as SDH. A thyroid storm will increase cerebral blood flow and correlate with an elevated cerebral blood volume, resulting in increased intracranial pressure. Therefore, careful and prompt preoperative preparation is needed to prevent patient mortality. A 33-year-old woman weighing 38 kg had a gradual loss of consciousness, vomiting, and headache and was diagnosed with subdural hematoma. The patient was examined in preparation for burrhole drainage. The patient had a known history of Down syndrome since birth, with an unknown history of hyperthyroidism. The patient exhibited thyroid storm, with a free T4 level exceeding 100 ng/dL and a Burch Wartofsky score of 50. Surgery during thyroid storm is a high-risk procedure but should be performed in emergencies with careful preparation and vigilance, especially against possible complications. The anesthesiologist’s role in perioperative management becomes crucial, especially in complicated cases.