That spontaneous subarachnoid hemorrhage can have many etiologies and be associated with many pathologic processes is an established fact.1-13 Increasing knowledge concerning spontaneous subarachnoid hemorrhage and improved diagnostic methods have made it possible to recognize a number of disease processes which may present as subarachnoid hemorrhage. Odom and others prophetically remarked about a large group of spontaneous subarachnoid hemorrhage classified as etiology unknown-&dquo;the larger group in which the cause of bleeding has not been determined-clarification will require a special long term study&dquo;.7-9. 14 Although spontaneous bleeding and bleeding as a result of minor trauma does occur in patients with factor XI deficiency, central nervous system bleeding is extremely rare and subarachnoid hemorrhage has seemingly been unreported as associated with or due to PTA deficiency. [15][16][17][18][19][20][21][22] In this paper we present a case in which the laboratory and clinical manifestations of both diseases are complete.
CASE HISTORYThis 45 year old male was admitted to the Brooklyn V.A. Hospital on 7/8/71 with a history of the sudden onset of nausea, vomiting and diarrhea on 6/27/71. The diarrhea responded to treatment by a local physician but intermittent vomiting was later accompanied by persistent headache. Because of the headache and mild confusion and &dquo;personality change&dquo; noted by the family the patient sought admission. Examination revealed a disoriented and confused male with normal vital signs. Cranial nerves including the fundi were normal. There was moderate nuchal rigidity. The deep tendon reflexes were depressed and equal. No pathologic reflexes were elicited. A positive Kernig sign was demonstrated. A spinal tap revealed grossly bloody spinal fluid in all tubes. The initial pressure was 330 mms of water and the supernant was xanthochromic. Microscopic examination revealed crenated and fresh RBC's. A culture of the spinal fluid revealed no growth. Chemistries were not done because of presence of gross blood. Angiography on 2 occasions revealed no abnormalities. Patient was treated conservatively and showed improvement. Coagulation studies were done and revealed coagulation time 18 minutes (Normal 5 to 10 minutes), partial thromboplastin time 117 seconds (control 67 seconds) which was corrected by at MOUNT ALLISON UNIV on June 25, 2015 ang.sagepub.com Downloaded from
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