A rare case of symmetrical four limb gangrene following emergency neurosurgery

•Postoperative sepsis and limb gangrene are uncommon but important complications of neurosurgery.•Peripheral gangrene should be suspected at the first signs of distal ischaemia.•Early diagnosis and intervention is crucial.•Early specialist and multi-disciplinary team input with close monitoring ensures better outcomes.

IntroductionThe authors report a case of symmetrical peripheral gangrene (SPG) following emergency neurosurgery.Presentation of caseA 35-year-old female presented to hospital in Thailand with nausea, headache, and subsequent seizures. She was found to have a large intracranial space-occupying lesion with mass effect. Following emergency surgical debulking and decompression, she suffered from severe sepsis with multiple organ failure, treated with high dose intravenous vasopressors and developed secondary gangrene in all four limbs. She was repatriated to the UK with a baseline GCS of 8 and multiple postoperative medical complications. With initial conservative management, the patient made a prolonged but satisfactory progression to recovery prior to semi-elective debridement and selected digit amputation of the gangrene.DiscussionThis is the first reported case of four limb symmetrical peripheral gangrene following an emergency craniotomy.ConclusionAlthough rare, SPG is a substantial complication with high mortality and morbidity and therefore should be especially taken into account for emergency intracranial pathologies in neurosurgical patients, particularly if they require emergency surgery.