Hassan Mohamed Sheikh, Bakir Ahmet, Adam Bakar Ali, Sidow Nor Osman, Ibrahim Abdiwahid Ahmed, Abdi Ishak Ahmed, Waberi Mohamud Mire
Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Somalia.
Department of Cardiology, Mogadishu Somali Turkish Training and Research Hospital, Somalia.
Ann Med Surg (Lond). 2022 Nov 17;84:104946. doi: 10.1016/j.amsu.2022.104946. eCollection 2022 Dec.
Subarachnoid hemorrhage (SAH) is mostly associated with head trauma. Non-traumatic subarachnoid hemorrhage is mostly due to vascular abnormalities: either hemorrhage from ruptured aneurysm or bleeding from arteriovenous malformation. Aneurysmal hemorrhage is the biggest cause in non-traumatic cases. Warfarin is associated with cerebral intraparenchymal hemorrhage, but it is rarely associated with SAH.
Here, we report the case of a 45-year-old male patient who was admitted to the neurology ward of our hospital due to acute ischemic stroke. The patient was treated with a vitamin K antagonist (warfarin). However, on the third day, his condition deteriorated (his GCS regressed from 11/15 to 5/15). His pupils were anisocoric. Brain CT showed extensive subarachnoid hemorrhage without intraparenchymal involvement. Cerebral magnetic resonance angiography ruled out aneurysmal rupture. The patient was intubated and transferred to the intensive care unit. Due to his poor condition, neurosurgical intervention could not be done. The patient was managed conservatively, but the patient passed away 4 days later in the intensive care unit.
Non-traumatic SAH is mostly caused by aneurysmal rupture. Warfarin increases the risk of intracranial hemorrhage and mostly causes intraparenchymal hemorrhage. Isolated warfarin-related SAH without parenchymal involvement is a rare event. Here we present a young male patient with an isolated warfarin-induced SAH.
Warfarin is rarely associated with isolated subarachnoid hemorrhage. This case highlights a young male patient with spontaneous SAH after warfarin therapy for acute ischemic stroke. Aneurysmal rupture and trauma should be excluded before a diagnosis of warfarin-induced SAH is made.
蛛网膜下腔出血（SAH）大多与头部外伤相关。非创伤性蛛网膜下腔出血主要归因于血管异常：要么是破裂动脉瘤出血，要么是动静脉畸形出血。动脉瘤性出血是非创伤性病例的最大病因。华法林与脑实质内出血相关，但很少与蛛网膜下腔出血相关。
在此，我们报告一例45岁男性患者，因急性缺血性卒中入住我院神经内科病房。该患者接受了维生素K拮抗剂（华法林）治疗。然而，第三天，他的病情恶化（格拉斯哥昏迷评分从11/15降至5/15）。他的瞳孔不等大。脑部CT显示广泛蛛网膜下腔出血，无脑实质受累。脑磁共振血管造影排除了动脉瘤破裂。患者被插管并转入重症监护病房。由于病情严重，无法进行神经外科干预。患者接受保守治疗，但4天后在重症监护病房死亡。
非创伤性SAH大多由动脉瘤破裂引起。华法林增加颅内出血风险，且大多导致脑实质内出血。孤立的与华法林相关且无实质受累的SAH是罕见事件。在此我们呈现一名年轻男性患者，患有孤立的华法林诱发的SAH。
华法林很少与孤立性蛛网膜下腔出血相关。本病例突出了一名在接受华法林治疗急性缺血性卒中后发生自发性SAH的年轻男性患者。在诊断华法林诱发的SAH之前，应排除动脉瘤破裂和外伤。
