Abstract
Introdution: A 51-year-old woman on warfarin thromboprophylaxis for transient ischemic attacks developed sudden onset nausea, vomiting, and decreased mental status, rapidly becoming comatose. Head computed tomography (CT) showed intracerebral hemorrhage, extending into all ventricular chambers, and acute obstructive hematocephalus requiring urgent ventricular drainage. CT angiogram showed no evidence of an aneurysm or vascular malformation. Methods: The pretreatment international normalized ratio (INR) of 4.9 was rapidly corrected with recombinant activated factor VII and an external ventricular drain was placed. Despite accurate positioning, the ventriculostomy thrombosed and became non-functional. Recombinant tissue plasminogen activator was given intraventricularly and resulted in partial ventricular decompression within 24 hours, with dramatic improvement in the patient's level of consciousness. Results: Repeated intraventricular fibrinolysis resulted in further reduction of the intraventricular hematoma within a few days and a good patient outcome. The patient did not require permanent ventricular shunt. Conclusion: To our knowledge, this is the first reported case of combined systemic enhancement of hemostasis and local fibrinolysis as a life-saving measure in intracranial hemorrhage.
Original language | English (US) |
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Pages (from-to) | 246-248 |
Number of pages | 3 |
Journal | Neurocritical Care |
Volume | 3 |
Issue number | 3 |
DOIs | |
State | Published - Dec 2005 |
Keywords
- Activated factor VII
- Intracranial hemorrhage
- Intraventricular hemorrhage
- Tissue plasminogen activator
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine
- Clinical Neurology