TITLE:
Extra Investigation Might Be Necessary in High-Risk CT-Negative Cerebrovascular Cases
AUTHORS:
Mohammad Sami Walid, Nadezhda Zaytseva
KEYWORDS:
Subdural Hematoma; Intracerebral Hemorrhage; Warfarin; Perfusion CT
JOURNAL NAME:
Neuroscience and Medicine,
Vol.4 No.2,
June
18,
2013
ABSTRACT:
Cerebrovascular accidents
occur in elderly patients in whom neurodegenerative changes increase the risk
of vascular permeation and concomitant intracranial bleeding. In rare cases,
intracerebral massive hemorrhage happens in hospitalized patients with apparently stable
clinical picture. We report two cases illustrating this phenomenon, discuss the
possible
pathomechanism involved in those tragic incidents and suggest possible
prevention measures for these patients. A negative CT image in a patient with
neurological symptoms, especially who are on warfarin with or without considerably elongated coagulation time, may be
subject to a sudden intracranial hemorrhage. Microvascular abnormalities might
be detected on perfusion CT imaging and should therefore be performed in all CT
negative patients with close observation for 24 hours before contemplating discharge.