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Spontaneous Intracerebral Hemorrhage Following a Blood Pressure Surge During Emergency Department Evaluation

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Abstract

Background

Chronic hypertension and anticoagulation are important risk factors for the development of intracerebral hemorrhage (ICH). Spontaneous ICH occurring in the Emergency Department (ED) following a normal unenhanced computed tomography (CT) scan of the brain and an acute blood pressure (BP) surge is exceedingly rare and has, to our knowledge, never been reported in the literature.

Methods

Single case observation in a suburban tertiary care medical center.

Results

A neurologically intact 72-year-old man whose BP and neurologic status were monitored during an ED evaluation suddenly became unresponsive following an acute BP surge. A CT of the brain shortly before the episode was normal; following the episode, a repeat CT demonstrated a large right ganglionic ICH.

Conclusions

We present a rare case of an elderly man on warfarin who developed a spontaneous ICH during an ED evaluation following an acute BP surge. We propose that the ICH occurred as a result of the BP surge and was contributed to by warfarin anticoagulation.

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Authors and Affiliations

  1. Department of Emergency Medicine, Kaiser Santa Clara Medical Center, 700 Lawrence Expressway, Santa Clara, CA, 95051, USA

    Joel T. Levis

  2. Stanford/Kaiser Emergency Medicine Residency Program, 701 Welch Road, Building C, Stanford, CA, 94305, USA

    Joel T. Levis & Charlene Kiang

  3. Department of Neuroscience, Kaiser Redwood City Medical Center, 1150 Veterans Boulevard, Redwood City, CA, 94063, USA

    Alexander C. Flint

Authors
  1. Joel T. Levis
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  2. Charlene Kiang
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  3. Alexander C. Flint
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Corresponding author

Correspondence to Alexander C. Flint.

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Levis, J.T., Kiang, C. & Flint, A.C. Spontaneous Intracerebral Hemorrhage Following a Blood Pressure Surge During Emergency Department Evaluation. Neurocrit Care 13, 109–112 (2010). https://doi.org/10.1007/s12028-010-9352-3

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  • DOI: https://doi.org/10.1007/s12028-010-9352-3

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