Korean J Crit Care Med.  2016 May;31(2):134-139. 10.4266/kjccm.2016.31.2.134.

Fatal Intracranial Hemorrhage in a Patient with Disseminated Intravascular Coagulation associated with Sepsis

• Baek HJ
• Lee DH
• Han KH
• Kim YM
• Kim H
• Cho B
• Lee I
• Choi K
• Yong H
• Hong G

• KMID: 2350921
• DOI: http://doi.org/10.4266/kjccm.2016.31.2.134

Abstract

In critically ill patients, disseminated intravascular coagulation (DIC) is a common and fatal hematological disorder. DIC is a physiological response to a variety of underlying stimuli that provoke generalized activation of the hemostatic mechanism and is common in septic patients and those with hematological or non-hematological malignant neoplasms. Bleeding is a common clinical feature, and diffuse or multiple-site mucocutaneous bleeding, such as petechia, ecchymosis and hemorrhage from gastrointestinal tract, is often seen. A 58-year-old male was recently diagnosed with intracranial hemorrhage (ICH) caused by DIC associated with sepsis. Mortality of ICH caused by DIC is very high because the underlying condition cannot be quickly treated. Awareness of the possibility of DIC developing in a critically ill patient and the need for immediate initiation of plasma or platelet replacement therapy are important. To the best of our knowledge, this is the first reported case of intracranial hemorrhage in a Korean patient with DIC associated with sepsis.

Keyword

disseminated intravascular coagulation; intracranial hemorrhage; sepsis

MeSH Terms

Blood Platelets
Critical Illness
Dacarbazine
Disseminated Intravascular Coagulation*
Ecchymosis
Gastrointestinal Tract
Hemorrhage
Humans
Intracranial Hemorrhages*
Male
Middle Aged
Mortality
Plasma
Sepsis*
Dacarbazine

Figure

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  Fig. 1. Initial chest radiography and abdominopelvic computed tomography. (A) The chest radiography revealed a history of a median sternotomy and replacement of a mitral valvular ring. (B) Abdominopelvic computed tomography revealed a few tiny stones with mild distension without wall thickening of the gall bladder.

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  Fig. 2. Initial brain computed tomography and magnetic resonance imaging. (A, B) Computed tomography revealed cerebromalacia with diffuse brain atrophy in the right lower frontal and left parietal areas. (C, D) Magnetic resonance imaging (fluid-attenuated inversion recovery) revealed encephalomalacic change in the right frontal and left parietal regions, the basal ganglia, and both cerebellar hemispheres.

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  Fig. 3. On hospital day 2, (A, B) brain computed tomography revealed an acute intracranial hemorrhage in the left frontal region, with a mass effect, and intraventricular hemorrhages evident over all ventricles.

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