Unusually quick resorption of an intracerebral hemorrhage in congenital afibrinogenemia

Abstract

Neuroimaging diagnostics of cerebral hemorrhage in congenitally afibrinogenic patients may be compromised by different pitfalls. We describe the case of a 28-year-old patient with the diagnosis of congenital afibrinogenemia who suffered a large intracerebral hemorrhage. Initial cerebral computed tomography showed typical bleeding, but follow-up cerebral CT scans 1 and 2 weeks later revealed an unusually quick and subtotal resorption of hemorrhage with only a small hypodense lesion within the former bleeding area left. Imaging findings and differential diagnosis are discussed with respect to previous reports about intracerebral hemorrhage in afibrinogenemia.

Afibrinogenemia caused by a novel homozygous missense mutation, FGB p.Cys241Tyr, in a male patient with recurrent intracranial bleeding: case report and review of literature

“…Unusually quick resorption of intracranial bleeds in an afibrinogenemia patient, similarly to our case, was reported in two patients 27,28 . Subtotal or total regression of the bleed was noted as soon as in 2–3 weeks, in contrast to the usual time of resorption of post‐traumatic bleeds of 5–7 weeks.…”

“…25,26 Unusually quick resorption of intracranial bleeds in an afibrinogenemia patient, similarly to our case, was reported in two patients. 27,28 Subtotal or total regression of the bleed was noted as soon as in 2-3 weeks, in contrast to the usual time of resorption of post-traumatic bleeds of 5-7 weeks. It can possibly be explained by abnormal clot formation in the extravasated blood, particularly in the absence or with delayed fibrinogen substitution.…”

“…It can possibly be explained by abnormal clot formation in the extravasated blood, particularly in the absence or with delayed fibrinogen substitution. 27 Further reports on ICH recurrence can also be found in the literature mainly in neonates or young children. [29][30][31] To sum up, we identified in the literature 7 cases of ICH recurrence in afibrinogenemia patients, one post-traumatic and 4 spontaneous (in two cases no clinical data were provided).…”

“…Subtotal or total regression of the bleed was noted as soon as in 2–3 weeks, in contrast to the usual time of resorption of post‐traumatic bleeds of 5–7 weeks. It can possibly be explained by abnormal clot formation in the extravasated blood, particularly in the absence or with delayed fibrinogen substitution 27 …”

Spinal Cord Infarction in Congenital Afibrinogenemia: A Case Report and Review of the Literature

“…Spontaneous, and sometimes catastrophic, intracerebral hemorrhages are also reported in patients with congenital afibrinogenemia. [17][18][19][20] In addition to hemorrhagic events, arterial and venous thrombotic and thromboembolic complications have been described, but remain exceptionally rare. [21][22][23][24][25][26] We herein report an afibrinogenemic patient with spinal ischemic stroke caused by VAD.…”