2026 Volume 48 Issue 2 Pages 78-83
Congenital fibrinogen disorder is a rare blood coagulation disorder. A 23-year-old woman suffered a subarachnoid hemorrhage at the age of 19, and she was diagnosed with congenital dysfibrinogenemia. Since no cerebral aneurysm was detected, the hemorrhage was thought to have been caused by coagulation dysfunction. Her father had been diagnosed with congenital afibrinogenemia. Subsequently, she visited our hospital complaining of a headache, and MRI revealed a left IC-PC aneurysm measuring about 5 mm in diameter. Due to a relatively high risk of rupture, endovascular coil embolization was planned. The blood fibrinogen level was 52 mg/dl. Accordingly, fibrinogen was administered 4 days prior to embolization. After confirming an increase in blood fibrinogen level to over 100 mg/dl, antiplatelet therapy was started. Embolization was completed without any hemorrhagic or thrombotic complications. Blood fibrinogen levels were monitored during the perioperative period, and additional fibrinogen concentrate was administered when indicated. Antiplatelet therapy was discontinued on the postoperative day 8, and she was discharged home with no neurological deficits on the postoperative day 11. This case demonstrates that the combination of fibrinogen concentrate supplementation and antiplatelet therapy represents a viable therapeutic approach for managing patients with congenital fibrinogen dysfunction complicated by an unruptured cerebral aneurysm, achieving successful outcomes without adverse events.
