title: Spontaneous intracerebral hemorrhage following a blood pressure surge during Emergency Department evaluation.
abstract: BACKGROUND
  Chronic hypertension and anticoagulation are important risk factors for the development of intracerebral hemorrhage (ICH). Spontaneous ICH occurring in the Emergency Department (ED) following a normal unenhanced computed tomography (CT) scan of the brain and an acute blood pressure (BP) surge is exceedingly rare and has, to our knowledge, never been reported in the literature.
  
  
  METHODS
  Single case observation in a suburban tertiary care medical center.
  
  
  RESULTS
  A neurologically intact 72-year-old man whose BP and neurologic status were monitored during an ED evaluation suddenly became unresponsive following an acute BP surge. A CT of the brain shortly before the episode was normal; following the episode, a repeat CT demonstrated a large right ganglionic ICH.
  
  
  CONCLUSIONS
  We present a rare case of an elderly man on warfarin who developed a spontaneous ICH during an ED evaluation following an acute BP surge. We propose that the ICH occurred as a result of the BP surge and was contributed to by warfarin anticoagulation.
authors.affiliation: Department of Emergency Medicine, Kaiser Santa Clara Medical Center, Santa Clara, CA 95051, USA.
authors.forename: Joel T
authors.initials: JT
authors.lastname: Levis
authors.forename: Charlene
authors.initials: C
authors.lastname: Kiang
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Flint
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy; D001794:Blood Pressure; D001921:Brain / Q000000981:diagnostic imaging; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology*; D004636:Emergency Service, Hospital; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology; D008297:Male; D014057:Tomography, X-Ray Computed; D014859:Warfarin / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin