Surgery helps patient survive Leptospirosis

CHENNAI: A 31-year-old male suffering from leptospirosis was saved through a rare surgery after he started bleeding into his brain.Hailing from a waterlogged area here, Rajan was initally diagnosed with a regular flu and was treated locally. Though the fever eased up after four days, the myalgia persisted till he found his urine was extremely yellow. He was referred to the Billroth Hospital where he was diagnosed with leptospirosis. Severe form of leptospirosis carries high case fatality rate of 15% to 40% and renal failure and haemorragic pneumonia are reasons for high mortality.His neurological status was steadily deteriorating and an MRI scan revealed a large subdural haematoma in his brain. An emergency left parieto-occipatal craniotomy procedure was done and 150 ml subdural haematoma (bloodin the brain) was evacuated. Despite a brief improvement, he started deteriorating again after 48 hours. There was a re-accumulation of blood in the operated side that warranted another surgery.Subsequent to this there was steady improvement and the fever began declining. Follow-up scan revealed very good evacuation of haematoma with no mass effect. At present his neurological condition has become fully normal. So far, barely three  cases of intracerebral bleeds have been reported, of which two were confirmed post mortem. The third one was a small intracerebral bleed reported from Iran which was medically managed.