SHM Converge Scientific Abstract ePoster Gallery-Periprocedural Intracranial Hemorrhage: A Review of Beta-Blocker Withdrawal

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This case report describes a 77-year-old woman with hypertension on metoprolol and stage IV uterine carcinosarcoma who developed a severe headache and acute intracranial hemorrhage about four hours after an endoscopy performed for acute anemia. Her home beta-blocker was held peri-procedurally because of concern for GI bleeding. The authors argue that this likely caused rebound tachycardia and hypertension, contributing to increased intracranial pressure and hemorrhage in the setting of a brain metastasis.<br /><br />On presentation, she had no focal neurologic deficits and was found to have marked metabolic and inflammatory abnormalities, including thrombocytopenia, renal dysfunction, hyponatremia, and elevated bilirubin and creatine kinase. CT of the head showed a left frontal lobe mass with central acute hemorrhage, mild mass effect, and vasogenic edema. She was treated with steroids and transferred to neuro-critical care. Follow-up imaging showed stable hemorrhage without progression. Her antihypertensive medications were restarted and adjusted, and she was discharged to pursue stereotactic radiotherapy. She later returned with respiratory failure from lung metastases and transitioned to comfort-focused care.<br /><br />The discussion reviews evidence on peri-procedural beta-blocker management. Continuing beta-blockers is generally associated with fewer cardiovascular events and lower mortality after noncardiac procedures, though it may increase vasopressor use and PACU stay. In contrast, beta-blocker withdrawal has been linked to rebound sympathetic activation, cardiovascular complications, and increased mortality. The authors note that metoprolol has been associated in some studies with perioperative stroke and hypotension, though this has not been consistently shown for other beta-blockers. The report emphasizes the need for individualized risk-benefit assessment when deciding whether to continue beta-blockers around procedures.

Asset Subtitle

Aaron Z. Reyes

Meta Tag

Author List Aaron Z. Reyes

Category Clinical Vignettes

Concept Beta-Blocker Withdrawal

Concept Intracranial Hemorrhage

Concept Rebound Tachycardia

Concept Rebound Hypertension

Concept Chronic Beta-Blocker Therapy

Distinguished Non-Finalist

Presenter Organization UCSD Health

Presenting Author Aaron Z. Reyes

Track Adult

Keywords

intracranial hemorrhage

beta-blocker withdrawal

metoprolol

uterine carcinosarcoma

brain metastasis

peri-procedural management

rebound hypertension

endoscopy

acute anemia

neurocritical care

Beta-Blocker Withdrawal

Intracranial Hemorrhage

Rebound Tachycardia

Rebound Hypertension

Chronic Beta-Blocker Therapy