Journal of Neurosciences in Rural Practice
Year : 2018  |  Volume : 9  |  Issue : 4  |  Page : 625-627

Emergent neurosurgical management of a rapidly deteriorating patient with acute intracranial hemorrhage and alcohol-related thrombocytopenia

1 Department of Neurological Surgery, University of California; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
2 Department of Neurological Surgery, University of California, San Francisco, CA, USA
3 Department of Surgery, University of California, San Francisco, CA, USA

Correspondence Address:
Hansen Deng
Department of Neurological Surgery, University of California, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94132
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jnrp.jnrp_50_18

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Alcohol intoxication is a common risk factor of traumatic brain injury (TBI) and carries a significant health-care burden on underserved patients. Patients with chronic alcohol use may suffer a spectrum of bleeding diatheses from hepatic dysfunction not well studied in the context of TBI. A feared sequela of TBI is the development of coagulopathy resulting in worsened intracranial bleeding. We report the clinical course of an intoxicated patient found down with blunt head trauma and concurrent alcoholic cirrhosis who was awake and responsive in the field. Hospital course was characterized by a rapidly deteriorating neurological examination with progressive subdural and subarachnoid hemorrhage and precipitating neurosurgical decompression and critical care management. Our experience dictates the need for timely consideration of the possibility of rapid deterioration from coagulopathic intracranial bleeding in the initial assessment of intoxicated patients with head trauma of unknown severity, for which a high index of suspicion for extra-axial hemorrhage should be maintained, along with the immediate availability of operating room and the necessary medical personnel.

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