Korean J Crit Care Med.  2015 Nov;30(4):336-342. 10.4266/kjccm.2015.30.4.336.

Delayed Traumatic Subarachnoid Hemorrhage in a Polytraumatized Patient with Disseminated Intravascular Coagulation

• Oh J
• Lee W
• Jang JY
• Jung P
• Kim S
• Kim J
• Pyen J
• Whang K
• Cho S

• KMID: 2156191
• DOI: http://doi.org/10.4266/kjccm.2015.30.4.336

Abstract

The precise mechanism involved in DIC and delayed traumatic subarachnoid hemorrhage (DT-SAH) remains unclear in multiple-trauma patients. Hereby, we describe a polytraumatized patient with DIC who died due to DT-SAH. A 75-year-old female patient was admitted to our Emergency Department complaining of abdominal pain and drowsiness after a pedestrian accident. Her initial brain computerized tomography (CT) finding was negative for intracranial injury. However, her abdominal CT scan revealed a collection of retroperitoneal hematomas from internal iliac artery bleeding after a compressive pelvic fracture. This event eventually resulted in shock and DIC. An immediate angiographic embolization of the bleeding artery was performed along with transfusion and anti-thrombin III. Her vital signs were stabilized without neurological change. Fourteen hours after admission, she suddenly became comatose, and her follow-up brain CT scan revealed a dense DT-SAH along the basal cisterns with acute hydrocephalus. This event rapidly prompted brain CT angiography and digital subtraction angiography, which both confirmed the absence of any cerebrovascular abnormality. Despite emergency extraventricular drainage to reverse the hydrocephalus, the patient died three days after the trauma. This paper presents an unusual case of DT-SAH in a polytraumatized patient with DIC.

Keyword

disseminated intravascular coagulation; polytrauma; taumatic subarachnoid hemorrhage

MeSH Terms

Abdominal Pain
Aged
Angiography
Angiography, Digital Subtraction
Arteries
Brain
Coma
Dacarbazine
Disseminated Intravascular Coagulation*
Drainage
Emergencies
Emergency Service, Hospital
Female
Follow-Up Studies
Hematoma
Hemorrhage
Humans
Hydrocephalus
Iliac Artery
Multiple Trauma
Shock
Sleep Stages
Subarachnoid Hemorrhage, Traumatic*
Tomography, X-Ray Computed
Vital Signs
Dacarbazine

Figure

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  Fig. 1. (A) The initial brain computed tomography (CT) images revealed no definite intracranial hemorrhagic lesion. (B) The follow-up brain CT revealed a dense cisternal subarachnoid hemorrhage.

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  Fig. 2. (A) The initial abdominal computed tomography revealed a pelvic bone fracture with retroperitoneal hematoma. (B) The preembolization pelvic angiography showed an extravasation of the internal iliac artery branch. (C) After embolization, no definite extravasation was confirmed through pelvic angiography.

• 

  Fig. 3. (A), (B), (C) According to digital subtraction angiography, no vascular abnormality was present. (D) We performed extraventricular drainage at the right Kocher’s point. The tapping pressure was higher than 250 mm CSF. CSF: cerebrospinal fluid.

Reference

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