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(Stroke. 1999;30:2479-2482.)
© 1999 American Heart Association, Inc.

Case Reports

Recurrent Spontaneous Intracerebral Hemorrhage in a Congenitally Afibrinogenemic Patient

Diagnostic Pitfalls and Therapeutic Options

J. M. L. Henselmans, MD, PhD; K. Meijer, MD; R. Haaxma, MD, PhD; J. Hew, MD J. van der Meer, MD, PhD

From the Department of Neurology (J.M.L.H., R.H.); Division of Hemostasis, Thrombosis, and Rheology (K.M., J. van der M.); and Department of Radiology (J.H.), University Hospital Groningen (Netherlands).

Correspondence to J.M.L. Henselmans, MD, PhD, Department of Neurology, Academic Hospital Groningen, Hanzeplein 1, 9713 GZ Groningen, Netherlands.

Background—Coagulation disorders can cause intracerebral bleeding that may be difficult to detect since subsequent aberrant clot formation may mask early detection. This is an important pitfall because, when diagnosed early, bleeding in these patients is treatable.

Case Description—A patient with congenital afibrinogenemia presented with recurrent hemiparesis. Spontaneous intracerebral hemorrhage was diagnosed, despite an initial negative CT scan. Diagnosis, therapy, and complications of therapy are discussed.

Conclusions—Intracerebral hemorrhage must be strongly suspected in any patient with a coagulation disorder presenting with matching clinical symptoms. Therapy must be installed immediately, before additional investigations, and should be continued even when initial neuroimaging is negative.

Key Words: afibrinogenemia • fibrinogen • follow-up studies • intracerebral hemorrhage • prevention, primary

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