Warfarin-induced Isolated Spontaneous Subarachnoid Hemorrhage: Rare Case Report

Abstract

Subarachnoid hemorrhage (SAH) is mostly associated with head trauma. Non-traumatic subarachnoid hemorrhage is mostly due to vascular abnormalities: either hemorrhage from ruptured aneurysm or bleeding from atriovenous malformation. Aneurysmal hemorrhage is the biggest cause in non-traumatic cases. Warfarin is associated with cerebral intraparenchymal hemorrhage, but it is rarely associated with SAH. Here, we report a case of a 45-year old male patient who was admitted to the neurology ward of our hospital due to acute ischemic stroke. The patient was treated with a vitamin K antagonist (warfarin). However, on the third day, his condition deteriorated (his GCS regressed from 11/15 to 5/15). Pupils were anisocoric. Brain CT done immediately showed extensive subarachnoid hemorrhage without intraparenchymal involvement. The patient was intubated and transferred to the intensive care unit. Due to his poor condition, neurosurgical intervention could not be done. The patient was managed conservatively, but the patient passed away 4 days later in the intensive care unit. Warfarin is rarely associated with subarachnoid hemorrhage, especially when it is only isolated subarachnoid hemorrhage. Aneurismal rupture and trauma should be excluded before diagnosis of warfarin related SAH is made.