Department of Pharmacy, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
J Clin Pharm Ther. 2019 Dec;44(6):958-962. doi: 10.1111/jcpt.13005. Epub 2019 Sep 26.
Many cases of rodenticide poisoning have been reported. Bromadiolone, often called a super-warfarin, is a second-generation dicoumarin rodenticide with long half-life. The main clinical manifestations of bromadiolone poisoning are excessive or inappropriate bleeding of skin mucosa, digestive tract and urinary tract. However, the phenomenon of central nervous system (CNS) toxicity is an uncommon medical emergency. We present a case of SAH and intracerebral haematoma mediated by bromadiolone intoxication, revealing that bromadiolone poisoning might cause intracerebral haematoma.
A 44-year-old woman presented with skin mucosa haemorrhage and haematuresis initially. The patient developed lethargy, headache, nausea and vomiting. The toxicology test result revealed that the presence of bromadiolone in her blood. Coagulation test results showed a longer prothrombin time (PT), activated partial thromboplastin time (APTT) and a high international normalized ratio (INR). SAH, frontal lobe haematoma, midline shift and brain oedema were discovered by skull CT examination. The coagulation disorders were addressed after the treatment of vitamin K and fresh frozen plasma. The intracranial symptoms were relieved after surgery and the treatment with mannitol.
This case suggests that bromadiolone poisoning should be diagnosed and treated as early as possible. Bromadiolone poisoning might cause SAH and intracerebral haematoma, which is rare but potentially lethal. It is important to strengthen the diagnosis and post-treatment monitoring.
已报告许多例杀鼠剂中毒。溴敌隆，通常称为超级华法林，是第二代茚满二酮类杀鼠剂，半衰期长。溴敌隆中毒的主要临床表现为皮肤黏膜、消化道和泌尿道过度或不适当出血。然而，中枢神经系统（CNS）毒性现象是一种罕见的医疗急症。我们报告了 1 例由溴敌隆中毒引起的蛛网膜下腔出血和脑内血肿病例，表明溴敌隆中毒可能导致脑内血肿。
一名 44 岁女性最初出现皮肤黏膜出血和血尿。患者出现嗜睡、头痛、恶心和呕吐。毒理学检测结果显示血液中存在溴敌隆。凝血试验结果显示凝血酶原时间（PT）、部分凝血活酶时间（APTT）延长和国际标准化比值（INR）升高。头颅 CT 检查发现蛛网膜下腔出血、额叶血肿、中线移位和脑肿胀。给予维生素 K 和新鲜冷冻血浆治疗后凝血障碍得到纠正。经手术和甘露醇治疗后颅内症状缓解。
本病例提示应尽早诊断和治疗溴敌隆中毒。溴敌隆中毒可能导致蛛网膜下腔出血和脑内血肿，虽然罕见但可能致命。重要的是要加强诊断和治疗后监测。
