[Intracranial hemorrhage with fluid level. A case report without coagulation alterations]

Area of Science:

• Neurology
• Radiology

Background:

• Intracranial hemorrhage with a fluid-blood level is a known complication in patients with coagulopathy or on anticoagulant therapy.
• This presentation is typically associated with specific underlying pathologies, including vascular malformations and neoplasms.

Observation:

• A 62-year-old male presented with a left putaminal hemorrhage exhibiting a fluid-blood level.
• Crucially, the patient demonstrated normal hemostasis at the time of admission.
• Follow-up imaging after a transient ischemic attack revealed associated hypodensities.

Findings:

• The case presents an unusual instance of intracranial fluid-blood level in a patient with normal coagulation parameters.
• The patient was later diagnosed with atrial fibrillation and mitral annulus calcification, suggesting potential embolic sources.
• The authors propose intraparenchymal hemorrhage, specifically an intrainfarct hematoma, as the likely cause of the fluid-blood level.

Implications:

• This case expands the differential diagnosis for intracranial fluid-blood levels beyond coagulopathy and known vascular lesions.
• It underscores the importance of considering intraparenchymal hemorrhage, even in the absence of bleeding disorders.
• Further investigation into the etiology of intraparenchymal hemorrhage may be warranted in select cases presenting with fluid-blood levels.