J Korean Soc Emerg Med.  2008 Apr;19(2):211-216.

A Case of Multiple Intracranial Hemorrhage Associated with Enoxaparin Treatment for an Acute Myocardial Infarction after Resuscitation

• Kim YK
• Oh SB

Abstract

We report a rare case of multiple intracerebral hemorrhage, subarachnoid hemorrhage, and intraventricular hemorrhage that developed after successful cardiopulmonary resuscitation (CPR). A 66-year-old man underwent CPR for about 10 minutes in his community hospital. At that time, his only sequela was ST depression in leads V3, and V4 with an ECG. There was no definite parenchymal lesion in the brain computed tomography (CT) scan taken in the community hospital, and the patient was transferred to Wonju christian hospital for post-resuscitation management. Upon arrival, echocardiographic findings showed akinesia of the anterior wall and anteroseptal wall together with decreased ejection fraction (34%). A cardiac enzyme assay showed a CK-MB concentration of 19.4 ng/ml and a troponin-I level of 1.66 ng/ml. He was mentally comatose and both pupils were isocoric and reflexive to light. We concluded that the cause of cardiac arrest was acute myocardial infarction (AMI), and the patient was treated with drugs including aspirin, clopidogrel, enoxaparin-sodium (1 mg/kg subcutaneous), and isosorbide dinitrate. At 10 hours after admission, a follow-up ECG showed ST elevation in lead I, aVL and all leads from V1 to V6. Right anisocoria was seen in neurologic examination at that time. A subsequent brain CT revealed multiple intracerebral hemorrhage, subarachnoid hemorrhage into all cisternal spaces, and intraventricular hemorrhage. Clotting evaluations yielded a prothrombin time (PT) of 14.6 sec., partial thromboplastin time (PTT) of 45.3 sec. and an INR of 1.32, and a hemoglobin count of 16.2 g/dL.

Keyword

Intracranial hemorrhage; Enoxaparin; Myocardial infarction; Resuscitation

MeSH Terms

Aged
Anisocoria
Aspirin
Brain
Cardiopulmonary Resuscitation
Cerebral Hemorrhage
Coma
Depression
Electrocardiography
Enoxaparin
Enzyme Assays
Follow-Up Studies
Heart Arrest
Hemoglobins
Hemorrhage
Hospitals, Community
Humans
International Normalized Ratio
Intracranial Hemorrhages
Isosorbide Dinitrate
Light
Myocardial Infarction
Neurologic Examination
Partial Thromboplastin Time
Prothrombin Time
Pupil
Reflex
Resuscitation
Subarachnoid Hemorrhage
Ticlopidine
Troponin I
Aspirin
Enoxaparin
Hemoglobins
Isosorbide Dinitrate
Ticlopidine
Troponin I