Intracranial hemorrhage with aplastic anemia: a case report and literature review

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  • Namatame Kaoru
    Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital
  • Nakae Ryuta
    Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital
  • Kaneko Junya
    Department of Emergency and Critical Care Medicine, Nippon Medical School Tama-Nagayama Hospital
  • Matsumoto Yoshiyuki
    Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital
  • Shimo Yukiko
    Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital
  • Teraoka Shintaro
    Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital
  • Obinata Yohei
    Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital
  • Hirabayashi Atsushi
    Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital
  • Wakita Satoshi
    Department of Hematology, Nippon Medical School Hospital
  • Yokobori Shoji
    Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital

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Other Title
  • 再生不良性貧血に合併した脳内出血の1例と文献レビュー
  • サイセイ フリョウセイ ヒンケツ ニ ガッペイ シタ ノウナイ シュッケツ ノ 1レイ ト ブンケン レビュー

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Abstract

<p>Intracranial hemorrhage in patients with blood disorders is potentially fatal. Here, we report a case of aplastic anemia complicated by intracranial hemorrhage with a favorable outcome.</p><p>A 37-year-old woman was rushed to a hospital with a headache. The patient was conscious and had no neurological findings. However, brain CT revealed a subcortical hemorrhage in the right temporal lobe. Blood tests showed pancytopenia. We suspected blood disorders such as aplastic anemia. The next day, the hematoma enlarged. The patient became drowsy and had left hemiplegia. Evacuation of the hematoma and decompressive craniectomy were performed. Due to severe brain swelling, ventricular drainage, temperature management, and osmotic diuretics were administered. Thrombocytopenia persisted perioperatively, thus platelets were transfused daily. The patient was extubated on the 12th day after brain swelling was relieved, and the hemiparesis improved. Bone marrow biopsy revealed aplastic anemia. Subsequently, immunosuppressive drugs were started.</p><p>Patients with aplastic anemia, who developed intracranial hemorrhage tended to have low platelets. Due to their tendency to bleed easily, when surgery is performed, blood transfusions and frequent monitoring of the platelet level during the preoperative to postoperative periods are essential. Early diagnosis and treatment of the underlying disease are important. </p>

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