Intracranial hemorrhage secondary to factor VIII and X deficiency. A case report.

Abstract

Introduction: Hemophilia, characterized by a deficiency in coagulation factors VIII (Hemophilia A) or IX (Hemophilia B), predisposes patients to severe bleeding events, including intracranial hemorrhage (ICH). ICH in hemophilic patients can occur at any age and has a high mortality rate.

Case Report: A 67-year-old man with hypertension was admitted with ataxia, severe headache, syncope, dysarthria, photophobia, and recurrent vomiting. Upon examination, he had a blood pressure of 150/90 mmHg, a heart rate of 57 bpm, and signs of first-degree AV block on an electrocardiogram. A brain CT scan revealed subarachnoid hemorrhage and ventricular dilation. Panangiography showed no lesions. On the second day, he developed cognitive impairment and underwent external ventricular drainage. The catheter was removed on the fifth day, and the patient was awake, followed commands, and moved all four limbs. After four days of hospitalization and treatment, he was discharged with clinical and neurological improvement. Seventeen days later, the patient returned with headache, dizziness, vomiting, and generalized weakness. A repeat CT scan showed a subdural hematoma. A craniectomy was performed to evacuate the hematoma. He spent nine days in the ICU with hyponatremia, hyposmolarity, thrombocytopenia, and a decrease in hemoglobin. Deficiency of factors VIII and X was confirmed. The patient received specific treatment for hemophilia and physiotherapy. A subsequent MRI showed significant resorption of the hematomas.

Conclusion: Intracranial hemorrhage should not be attributed exclusively to trauma or vascular rupture. Investigating other etiologies, such as coagulopathies and mild forms like hemophilia, is essential. Close follow-up, evaluating risk factors and comorbidities, is crucial for timely diagnosis and treatment.