Recurrent spontaneous intracerebral hemorrhage in a congenitally afibrinogenemic patient: diagnostic pitfalls and therapeutic options.
BACKGROUND
Coagulation disorders can cause intracerebral bleeding that may be difficult to detect since subsequent aberrant clot formation may mask early detection. This is an important pitfall because, when diagnosed early, bleeding in these patients is treatable.


METHODS
A patient with congenital afibrinogenemia presented with recurrent hemiparesis. Spontaneous intracerebral hemorrhage was diagnosed, despite an initial negative CT scan. Diagnosis, therapy, and complications of therapy are discussed.


CONCLUSIONS
Intracerebral hemorrhage must be strongly suspected in any patient with a coagulation disorder presenting with matching clinical symptoms. Therapy must be installed immediately, before additional investigations, and should be continued even when initial neuroimaging is negative.
Henselmans
J M
JM
Department of Neurology, University Hospital Groningen, Netherlands.
Meijer
K
K
Haaxma
R
R
Hew
J
J
van der Meer
J
J
D000347:Afibrinogenemia / Q000151:congenital*; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005169:Factor VIII / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005340:Fibrinogen / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005353:Fibronectins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005500:Follow-Up Studies; D006490:Hemostatics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D010291:Paresis / Q000209:etiology; D011655:Pulmonary Embolism / Q000139:chemically induced; D012008:Recurrence; D014057:Tomography, X-Ray Computed
D005353:Fibronectins; D006490:Hemostatics; C026912:cryoprecipitate coagulum; D005169:Factor VIII; D005340:Fibrinogen