[Intracranial hemorrhage associated with aplastic anemia]

Area of Science:

• Neurology
• Hematology

Background:

• Aplastic anemia poses a significant risk for fatal intracranial hemorrhage.
• Understanding the multifactorial nature of hemorrhage in this context is crucial.

Observation:

• Four patients experienced six episodes of intracranial hemorrhage (intracerebral, subarachnoid, subdural) without trauma.
• Hemorrhagic episodes recurred over approximately one year, indicating a persistent tendency.
• Hemorrhage presentation varied in site, type, and severity, suggesting complex causes beyond thrombocytopenia.

Findings:

• Conservative management, including platelet-rich plasma transfusion, glycerol, and steroids, showed positive results.
• Continuous spinal drainage proved safe and effective for managing subarachnoid hemorrhage.
• Severe cases with diffuse, ill-defined high-density areas on CT scans (resembling contusional hemorrhage) benefited from craniotomy with blood evacuation and splenectomy.

Implications:

• Early recognition and tailored management strategies are vital for improving outcomes in aplastic anemia patients with intracranial hemorrhage.
• Multifactorial hemorrhagic tendencies require comprehensive therapeutic approaches.
• Surgical intervention should be considered for severe, deteriorating cases.