Multifocal subdural hematomas as the presenting sign of acquired hemophilia A: a case report

BMC Research Notes

Vineeta Singh¹  Aimee Aysenne¹  Mark J Burish² 

[1] Department of Neurology, University of California, San Francisco, USA;505 Parnassus Ave, Room M-798, Box 0114, San Francisco, CA 94143-0114, USA

关键词: Critical care;    Spinal cord;    Lupus;    Secondary headache syndrome;    Intracranial hemorrhage;    Nontraumatic subdural hematoma;    Acquired hemophilia A;   

Others  :  1134312
DOI  :  10.1186/1756-0500-7-134

 received in 2014-03-02, accepted in 2014-03-04,  发布年份 2014

【 摘 要 】

Background

Acquired hemophilia A (AHA) is a rare coagulopathy linked to a variety of etiologies including autoimmune diseases, neoplasms, diabetes, respiratory diseases, and the post-partum state. While bleeding in AHA is often seen in mucocutaneous or intramuscular locations, intracranial and intraspinal bleeds are exceedingly rare.

Case presentation

We report an unusual case of spontaneous multifocal subdural hematomas in a 25 year old Asian woman with lupus who presented with headache and backache, and was found to have an elevated partial thromboplastin time (PTT) level and new diagnosis of AHA.

Conclusions

Subdural hematomas as the initial sign of AHA are all but unknown in the medical literature. We bring this entity to the attention of the neurology community because lumbar puncture and/or conventional angiogram are often indicated in the work-up of idiopathic multifocal subdural hematomas, but may be dangerous in patients with AHA.

【 授权许可】

   
2014 Burish et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Collins PW, Hirsch S, Baglin TP, Dolan G, Hanley J, Makris M, Keeling DM, Liesner R, Brown SA, Hay CRM: Acquired hemophilia A in the United Kingdom: a 2-year national surveillance study by the United Kingdom Haemophilia Centre Doctors’ Organisation. Blood 2007, 109:1870-1877.
• [2]Yee TT, Taher A, Pasi KJ, Lee CA: A survey of patients with acquired haemophilia in a haemophilia centre over a 28-year period. Clin Lab Haematol 2000, 22:275-278.
• [3]Philipp C: The aging patient with hemophilia: complications, comorbidities, and management issues. Hematology Am Soc Hematol Educ Program 2010, 2010:191-196.
• [4]Witmer C, Presley R, Kulkarni R, Soucie JM, Manno CS, Raffini L: Associations between intracranial haemorrhage and prescribed prophylaxis in a large cohort of haemophilia patients in the United States. Br J Haematol 2011, 152:211-216.
• [5]Nakar C, Cooper DL, DiMichele D: Recombinant activated factor VII safety and efficacy in the treatment of cranial haemorrhage in patients with congenital haemophilia with inhibitors: an analysis of the Hemophilia and Thrombosis Research Society Registry (2004–2008). Haemophilia 2010, 16:625-631.
• [6]Ljung RCR: Intracranial haemorrhage in haemophilia A and B. Br J Haematol 2008, 140:378-384.
• [7]Bonnaud I, Saudeau D, de Toffol B, Autret A: Recurrence of spontaneous subdural haematoma revealing acquired haemophilia. Eur Neurol 2003, 49:253-254.
• [8]Micic D, Williams EC, Medow JE: Cerebellar hemorrhage as a first presentation of acquired hemophilia A. Neurocrit Care 2011, 15:170-174.
• [9]Mashiko R, Yamamoto T, Sato M, Noguchi S, Matsumura A: Acquired hemophilia first manifesting as life-threatening intracranial hemorrhage: case report. Neurol Med Chir (Tokyo) 2009, 49:93-95.
• [10]Saito R, Takahashi T, Endo H, Kimura N, Kaneko U: [A case of subarachnoid hemorrhage complicated by acquired hemophilia]. No Shinkei Geka 2009, 37:1215-1219.
• [11]Shetty S, Bhave M, Ghosh K: Acquired hemophilia a: diagnosis, aetiology, clinical spectrum and treatment options. Autoimmun Rev 2011, 10:311-316.
• [12]Collins P, Baudo F, Huth-Kühne A, Ingerslev J, Kessler CM, Castellano MEM, Shima M, St-Louis J, Lévesque H: Consensus recommendations for the diagnosis and treatment of acquired hemophilia A. BMC Res Notes 2010, 3:161. BioMed Central Full Text
• [13]Franchini M, Gandini G, Di Paolantonio T, Mariani G: Acquired hemophilia A: a concise review. Am J Hematol 2005, 80:55-63.
• [14]Ichimura S, Horiguchi T, Inoue S, Yoshida K: Nontraumatic acute subdural hematoma associated with the myelodysplastic/myeloproliferative neoplasms. J Neurosci Rural Pract 2012, 3:98-99.
• [15]Da Rocha AJ, Saade N, da Silva AZ: Meningioma associated with non-traumatic subdural hematoma: an outstanding appearance of this common intracranial tumor. Arq Neuropsiquiatr 2013, 71:417.
• [16]Barami K, Ko K: Ruptured mycotic aneurysm presenting as an intraparenchymal hemorrhage and nonadjacent acute subdural hematoma: case report and review of the literature. Surg Neurol 1994, 41:290-293.
• [17]Kominato Y, Matsui K, Hata Y, Matsui K, Kuwayama N, Ishizawa S, Takizawa H: Acute subdural hematoma due to arteriovenous malformation primarily in dura mater: a case report. Leg Med (Tokyo) 2004, 6:256-260.
• [18]Ishikawa E, Sugimoto K, Yanaka K, Ayuzawa S, Iguchi M, Moritake T, Kobayashi E, Nose T: Interhemispheric subdural hematoma caused by a ruptured internal carotid artery aneurysm: case report. Surg Neurol 2000, 54:82-86.
• [19]Fu M, Omay SB, Morgan J, Kelley B, Abbed K, Bulsara KR: Primary central nervous system vasculitis presenting as spinal subdural hematoma. World Neurosurg 2012, 78:192.E5-192.E8.
• [20]Lee MS, Kim WC: Intracranial hemorrhage associated with idiopathic thrombocytopenic purpura: report of seven patients and a meta-analysis. Neurology 1998, 50:1160-1163.
• [21]Choi S, Brull R: Neuraxial techniques in obstetric and non-obstetric patients with common bleeding diatheses. Anesth Analg 2009, 109:648-660.
• [22]Lossing S, Kasper K, Feinstein I: Detection of factor VIII inhibitors with the partial thromboplastin time. Blood 1977, 49:793-797.