Intracranial hemorrhage in patients with blood disorders is potentially fatal. Here, we report a case of aplastic anemia complicated by intracranial hemorrhage with a favorable outcome.
A 37-year-old woman was rushed to a hospital with a headache. The patient was conscious and had no neurological findings. However, brain CT revealed a subcortical hemorrhage in the right temporal lobe. Blood tests showed pancytopenia. We suspected blood disorders such as aplastic anemia. The next day, the hematoma enlarged. The patient became drowsy and had left hemiplegia. Evacuation of the hematoma and decompressive craniectomy were performed. Due to severe brain swelling, ventricular drainage, temperature management, and osmotic diuretics were administered. Thrombocytopenia persisted perioperatively, thus platelets were transfused daily. The patient was extubated on the 12th day after brain swelling was relieved, and the hemiparesis improved. Bone marrow biopsy revealed aplastic anemia. Subsequently, immunosuppressive drugs were started.
Patients with aplastic anemia, who developed intracranial hemorrhage tended to have low platelets. Due to their tendency to bleed easily, when surgery is performed, blood transfusions and frequent monitoring of the platelet level during the preoperative to postoperative periods are essential. Early diagnosis and treatment of the underlying disease are important.
