2025 Volume 53 Issue 4 Pages 231-236
Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disease characterized by thrombocytopenia due to autoantibodies against platelet membrane proteins. Intracranial hemorrhage (ICH) is a rare but severe complication of ITP. We present a case of a 40-year-old female with ICH caused by a ruptured arteriovenous malformation (AVM) in the context of ITP and heart failure. Emergency craniotomy and hematoma evacuation were performed after the preoperative platelet transfusion. Perioperative management focuses on controlling venous bleeding and intracranial pressure complicated by elevated central venous pressure due to heart failure. AVM embolization was performed before cranioplasty to reduce the risk of rebleeding. Rigorous management of heart failure contributed to stabilizing the cerebral edema and bleeding. Persistent thrombocytopenia and multifocal cerebral hemorrhages were observed postoperatively. Corticosteroids and intravenous immunoglobulin therapy were administered, resulting in partial stabilization, and the patient was transferred to a rehabilitation facility. This case highlights the critical importance of a multidisciplinary and strategic approach in managing the interplay between ITP, ruptured AVM, and heart failure, particularly in the context of life-threatening complications.
