Plasma Thromboplastin Antecedent Deficiency and Subarachnoid Hemorrhage

Abstract

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

Factor XI deficiency and its management

“…In contrast to severe haemophilia A and B, spontaneous bleeding is not usually a feature, but can occur. Cases have been reported of individuals who suffered a massive haemothorax [13], a cerebral haemorrhage [24], a subarachnoid haemorrhage [25], and a spinal epidural haematoma with Brown–Sequard syndrome [26]. Spontaneous haemarthroses are rare but have been reported, even in individuals with partial deficiency [27].…”

Cerebellar Hemorrhage due to Factor XI Deficiency

“…Cerebral hemorrhage has already occasionally been described in association with factor XI deficiency [7,8]. However, in these cases, other risk factors such as high blood pressure were present [7].…”

A surgical case of cerebral hemorrhage in a patient with factor XI deficiency

“…Seven hemorrhagic cases have been reported related to the central neural system in FXI deficiency and most cases, except one, were diagnosed after admission. Among these seven cases, there were two cases of subarachnoid hemorrhage (SAH) [7,8], two cases of spinal hemorrhage [6,10], and one case of cerebellar hemorrhage [4] who underwent surgical treatment. Both SAHs were due to ruptured aneurysm; one was treated using the clipping method and another the coiling method, which reportedly led to a second episode of SAH due to aneurysmal revascularization and rupture.…”

“…In general, patients with FXI deficiency are known to have unpredictable bleeding tendencies after surgery [1,2]. To date, only seven hemorrhagic cases related to the central neural system have been reported in FXI deficiency [4][5][6][7][8][9][10]. Herein, we report a case of cerebral hemorrhage in a FXI deficiency patient who was first diagnosed after surgery.…”