A case of repeated rupture of esophageal varices during the treatment of a subarachnoid hemorrhage

Abstract

  We report the case of a 73‒year‒old woman with a history of hepatitis C who experienced a sudden occipital headache. The patient arrived at our hospital by ambulance. Head computed tomography revealed a subarachnoid hemorrhage and a left internal carotid‒posterior communicating artery bifurcation aneurysm. Hence, craniotomy aneurysm clipping was performed.

  Hematemesis due to the rupture of esophageal varices occurred during antithrombotic therapy for cerebral vasospasm on Day 8. Additionally, on Day 10, the patient suffered impaired consciousness and left hemiplegia due to right internal carotid artery stenosis.

  On day 11, the patient underwent carotid endarterectomy, followed by endoscopic injection sclerotherapy on Day 32. Six months later, the patient was discharged with a modified Rankin Scale score of 2. No recurrence of esophageal varices had been noted four years later.

  Cirrhosis has been associated with aneurysmal subarachnoid hemorrhages. Gastrointestinal bleeding, including bleeding due to ruptured esophagogastric varices, may occur during antithrombotic therapy. While treating stroke patients with a history of cirrhosis, neurosurgeons should collaborate with hepatologists and specialists in hemorrhage management.