title: A surgical case of cerebral hemorrhage in a patient with factor XI deficiency.
abstract: A 63-year-old man suddenly presented with right hemiplegia and was taken to our hospital. Computed tomography (CT) scan revealed subcortical hemorrhage of the left parietal lobe. He had no medical history except hypertension; thus, it initially appeared to be a typical hypertensive hemorrhage. However, blood analysis showed an abnormally elevated activated partial thromboplastin time. One hour after admission, his Glasgow Coma Scale fell from 14 to 11. We performed an echo-guided stereotaxic removal of the hematoma. He improved immediately and was diagnosed with congenital factor XI (FXI) deficiency a few days after surgery. FXI deficiency, described as hemophilic syndrome C, rarely manifests as spontaneous bleeding, but surgical intervention has been known to manifest as bleeding. This case highlights the importance of evaluation of coagulopathies in patients with intracerebral hemorrhage before surgery, and, in cases wherein blood analysis results suggest coexisting coagulation disorders, less invasive surgical methods would likely lead to good outcomes.
authors.affiliation: Department of Neurosurgery, Nantan General Hospital, Nantan-city, Kyoto, Japan. yoursongmysong@hotmail.com
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Goto
authors.forename: Ichita
authors.initials: I
authors.lastname: Taniyama
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Ebisu
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Mineura
mesh_terms: D002543:Cerebral Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005173:Factor XI Deficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006406:Hematoma / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010296:Parietal Lobe / Q000000981:diagnostic imaging / Q000601:surgery*; D010314:Partial Thromboplastin Time; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed