A rare cause of fatal intracranial haemorrhage.
BACKGROUND
We report the case of a 53-year-old farmer with a 5-day history of severe headache, photophobia and neck stiffness. Full blood count (platelets 173), coagulation screen were normal throughout. Liver function tests remained normal apart from an elevated gamma-GT (156). CT Brain was normal. CSF analysis showed a WCC of 454/mm(3) (60% lymphocytes), elevated CSF protein (1.42 g/l) and a normal CSF glucose. He was commenced on IV antibiotics and IV acyclivor and improved. On day 3 of admission, he complained of a sudden severe headache, became unresponsive (GCS 3/15).


METHODS
CT Brain showed a massive left intraventricular haemorrhage. He died 4 days later. Subsequent serum serology for leptospirosis was positive. A repeat sample taken 4 days post-admission, showed a rising IgM indicating active leptospirosis. Detailed pathological examination confirmed intracerebral haemorrhage with normal cerebral vasculature.


CONCLUSIONS
Leptospirosis is a rare cause of intracerebral haemorrhage even in the absence of coagulopathy.
Neligan
A
A
Department of Neurology, Mercy University Hospital, Grenville Place, Cork, Ireland. a.neligan@ion.ucl.ac.uk
Mullins
G M
GM
O'Sullivan
S S
SS
Fitzgerald
P
P
Harrington
H
H
D017809:Fatal Outcome; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology* / Q000382:microbiology; D007922:Leptospirosis / Q000150:complications* / Q000188:drug therapy; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged