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Neurologic complications of disseminated intravascular coagulation
Insights
Disseminated intravascular coagulation (DIC) can cause severe central nervous system (CNS) pathology, including bleeding and infarction. Early identification of CNS dysfunction in patients with bleeding disorders is crucial for diagnosis and management.
Area of Science:
- Neurology
- Hematology
- Pathology
Background:
- Bleeding disorders and neurologic abnormalities often coexist.
- Disseminated intravascular coagulation (DIC) is a complex condition with potential CNS manifestations.
- Distinguishing CNS pathology due to DIC from concurrent conditions is clinically significant.
Purpose of the Study:
- To investigate central nervous system (CNS) pathology associated with disseminated intravascular coagulation (DIC).
- To define the clinical settings where CNS dysfunction due to DIC arises.
- To differentiate neurologic complications directly caused by DIC from those in patients with concurrent DIC.
Main Methods:
- Retrospective analysis of 65 patients with bleeding disorders and neurologic abnormalities over 4 years.
- Inclusion criteria: neurologic disorder with clinical bleeding and laboratory/postmortem evidence of DIC.
- Categorization into Group I (cerebral bleeding/infarction at DIC onset) and Group II (DIC without postmortem CNS hemorrhage/infarction).
Main Results:
- Twenty-four of 65 patients met diagnostic criteria for DIC with neurologic abnormalities.
- Group I (10 patients) showed cerebral bleeding or infarction at DIC onset.
- Group II (14 patients) had DIC but no postmortem evidence of brain hemorrhage or infarction.
- Malignancy with stroke-like symptoms may indicate DIC and nonbacterial thrombotic endocarditis.
- Common neurologic complications include large vessel occlusion, obtundation, coma, subarachnoid hemorrhage, and multiple hemorrhages/infarctions.
Conclusions:
- Disseminated intravascular coagulation (DIC) is associated with significant central nervous system (CNS) pathology.
- Neurologic complications of DIC encompass vascular events, altered consciousness, and hemorrhages.
- Understanding the specific CNS manifestations is vital for managing patients with bleeding disorders and DIC.
Abstract:
Sixty-five patients with a bleeding disorder and coexistent neurologic abnormalities were examined over a 4-year period to determine: (1) the CNS pathology due to disseminated intravascular coagulation (DIC); (2) the clinical setting in which CNS dysfunction due to DIC occurs; and (3) the neurologic complications of DIC as opposed to those patients dying with concurrent DIC. Criteria for inclusion in the study were the combination of: (1) a neurologic disorder in a patient with clinical evidence of a bleeding disorder; and (2) evidence of DIC by laboratory criteria or the detection of fibrin thrombi in multiple organs at postmortem. Twenty-four of 65 patients met these diagnostic criteria, including 14 men and 10 women, aged 24 to 84 years. Autopsies were obtained in 17 patients. These patients were divided into two groups Group I consisted of 10 patients with evidence of cerebral bleeding or infarction at the onset of DIC. Group II consisted of 14 patients who met the diagnostic criteria for DIC but did not demonstrate postmortem evidence of hemorrhage or infarction in the brain. Patients with malignancy who present with findings suggestive of a large-vessel stroke are likely to have DIC and nonbacterial thrombotic endocarditis. The most common neurologic complications of DIC are large vessel occlusion, obtundation and coma, subarachnoid hemorrhage, and multiple cortical and brainstem hemorrhages and infarction.