Intracranial Hemorrhage Associated with Nontraumatic Disseminated Intravascular Coagulation

Abstract

The authors report four cases of intracranial hemorrhage associated with nontraumatic disseminated intravascular coagulation (DIC). Two cases demonstrated a sudden onset of intracerebral hemorrhage. The other two showed chronic subdural hematoma initially, followed by acute multiple intracranial hemorrhages or general hemorrhagic diathesis. The underlying disorders were glioblastoma multiforme, thoracoabdominal aortic aneurysm, acute promyelocytic leukemia, and stomach cancer associated with disseminated carcinomatosis of the bone marrow. All patients died eventually. When the underlying disorder has a rare incidence of DIC as in glioblastoma multiforme or thoracoabdominal aortic aneurysm, the possibility of DIC and the need for immediate initiation of replacement therapy should be recognized, although the mortality is very high because the underlying disorder cannot be eliminated quickly. When the underlying disorder has a high incidence of DIC as in acute promyelocytic leukemia or disseminated carcinomatosis of the bone marrow, it is mandatory to start replacement therapy and treatment for the underlying disorder simultaneously. DIC can be controlled when the treatment for the underlying disorder is effective.

Surgical Treatment of Chronic Subdural Hematoma in 500 Consecutive Cases: Clinical Characteristics, Surgical Outcome, Complications, and Recurrence Rate.

“…Age, systemic complications such as cardiovascular disease in elderly patients, coagulopathy, and poor preoperative neurological state are contributory causes of postoperative death. 7,15,21,35) In the present study, 50% of deaths were due to DIC. Statistical analysis also showed that coagulation disturbance was significantly correlated to poor outcome.…”

Risk score model for fatal intracranial hemorrhage in acute leukemia

“…20,23,[39][40][41][42][43] In contrast to the improvement in survival and decrease of hemorrhagic complications resulting from the introduction of ATRA, changes in hemorrhagic mortality have been reported to be minimal. 10 In our study, FICH was not decreased after ATRA use (data not shown).…”

Fatal Intracranial Hemorrhage in a Patient with Disseminated Intravascular Coagulation associated with Sepsis

“…But, there are other causes such as autoregulatory dysfunction with excessive cerebral blood flow (e.g., reperfusion injury, hemorrhagic transformation, cold exposure), rupture of an aneurysm or arteriovenous malformation and altered hemostasis (e.g., thrombolysis, anticoagulation, bleeding diathesis). [5] In our case, widespread thrombin generation and clotting results in coagulopathies and bleeding tendency from depletion of coagulation factors, platelets and secondary fibrinolysis with resultant hemorrhage. [13] ICH associated with non-traumatic DIC is often accompanied by encephalopathy.…”

“…[11] ICH associated with DIC has been reported in non-sepsis patients. [4,5,15,16] Radiological findings of subdural hematoma, subarachnoid and massive lobar hemorrhages, and hemorrhagic infarcts (often in association with venous sinus thrombosis), have been occasionally described. [5,[15][16][17] However, reports on ICH associated with DIC caused by sepsis are rare in English-language literature.…”

“…[4,5,15,16] Radiological findings of subdural hematoma, subarachnoid and massive lobar hemorrhages, and hemorrhagic infarcts (often in association with venous sinus thrombosis), have been occasionally described. [5,[15][16][17] However, reports on ICH associated with DIC caused by sepsis are rare in English-language literature. [11,18] Wijdicks et al [11] reported a case of subcortical hemorrhage in two patients with DIC associated with sepsis; both patients died about 2 weeks after sudden-onset hemorrhage.…”