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Abstract Details

Delayed Posttraumatic Intracranial Hemorrhage in a Patient not on Antithrombotic Therapy
Neuro Trauma and Critical Care
P14 - Poster Session 14 (11:45 AM-12:45 PM)
Delayed traumatic intracranial hemorrhage after a head injury is a rare phenomenon. Current literature has shown it to be more frequent in patients on antithrombotic therapy. However, there is limited data on delayed posttraumatic acute intracerebral hemorrhage. We present a case of a patient with post-traumatic hemorrhage seen 25 days after the initial event.

Case Report: A 74-year-old man with tobacco use presented with head trauma following a fall while climbing down a ladder. Initial computed tomography head (CTH) showed multifocal sub-centimeter bilateral parenchymal hemorrhages and scattered traumatic subarachnoid hemorrhages. With a normal neurologic examination and a stable repeat CTH, he was discharged home. 25 days later, he presented with acute onset left-sided arm and leg weakness. CTH was consistent with large right frontoparietal parenchymal hemorrhage with associated edema, subdural hematoma, subarachnoid and intraventricular extension, along with a 5 mm leftward midline shift at the level of cingulate gyrus. Angiogram of the head was unremarkable for underlying malformations. Magnetic resonance imaging of the brain was unremarkable for an acute infarction, mass or cerebral amyloid angiopathy. He was diagnosed with delayed posttraumatic acute intracerebral hemorrhage.

Delayed posttraumatic intracranial hemorrhage is uncommon. The pathogenesis remains elusive, but likely multifactorial. Several hypotheses include vascular degeneration, metabolic derangements, local hypoxia, and dysautoregulation caused by the coalesced blood from the initial contusion. The symptom-free interval between trauma and onset of symptoms is reported to mostly range between 1 to 15 days, on average of 5 days. Our case adds to the growing evidence of delayed posttraumatic intracranial hemorrhage with a longer interval of 25 days, despite not being on antithrombotic or anticoagulant therapy.
Victoria Qizhi Tay
Miss Tay has nothing to disclose.
Sayyeda Zahra, MD (Lehigh Valley Health Network) Dr. Zahra has nothing to disclose.
Preet M. Varade, MD (Lehigh Valley Hospital - Cedar Crest) Dr. Varade has nothing to disclose.