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A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
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Spontaneous rectus sheath hematoma: two variant cases.

Kamesh Sivagnanam1, Vatsal Ladia1, Vedang Bhavsar2

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Area of Science:

  • Medical Case Reports
  • Internal Medicine
  • Emergency Medicine

Background:

  • Spontaneous rectus sheath hematoma (SRSH) is a rare but potentially serious condition.
  • Increasing use of antithrombotic agents contributes to a potential rise in SRSH incidence.
  • SRSH can present with diverse clinical manifestations and etiologies.

Purpose of the Study:

  • To present two distinct cases of spontaneous rectus sheath hematoma.
  • To highlight varied presentations and management strategies for SRSH.
  • To emphasize the importance of clinician awareness regarding SRSH.

Main Methods:

  • Case report of a 71-year-old woman with active bleeding SRSH managed surgically.
  • Case report of a 64-year-old woman with non-bleeding SRSH managed conservatively.
  • Review of clinical presentation, diagnostic imaging (CT), and treatment outcomes.

Main Results:

  • Successful surgical evacuation of a large, actively bleeding SRSH in a patient on heparin therapy.
  • Conservative management of a large SRSH in a patient with Wegener's Granulomatosis.
  • Both patients demonstrated positive outcomes following their respective treatments.

Conclusions:

  • SRSH management should be tailored to the clinical presentation, including active bleeding status.
  • Clinicians must maintain a high index of suspicion for SRSH, considering both typical and atypical causes.
  • Anticoagulant use and underlying inflammatory conditions are important considerations in SRSH etiology.