Septic Shock After Surgery in Arnold-Chiari Malformation Type I: A Case Report.

Abstract

Background: Arnold-Chiari Malformation Type I (ACM-I) is a congenital disorder that can lead to severe neurological symptoms. While decompression surgery is the standard treatment, postoperative complications such as cerebrospinal fluid (CSF) leakage and infections can result in critical outcomes. Here, we report a case of septic shock following decompression surgery in a patient with ACM-I, emphasizing the challenges in postoperative critical care management.

Case presentation: A 45-year-old woman with rheumatoid arthritis and progressive neurological symptoms underwent decompression surgery for ACM-I. On postoperative day five, CSF leakage was noted at the surgical site, accompanied by fever and leukocytosis. Despite broad-spectrum antibiotics, the patient developed septic shock, requiring mechanical ventilation and vasopressor support. CSF cultures revealed Acinetobacter baumannii infection, necessitating surgical debridement and intrathecal colistin. Despite aggressive management, the patient succumbed to septic shock.

Conclusion: This case highlights the critical importance of early detection and aggressive management of postoperative infections in neurosurgical patients. The occurrence of CSF leakage and subsequent septic shock underscores the need for meticulous postoperative monitoring to prevent fatal complications. Timely intervention, including early microbiological assessment and individualized antibiotic therapy, is essential for improving outcomes in high-risk patients.