Acute and Critical Care

Case Reports

Neurosurgery/Hematology
Fatal Intracranial Hemorrhage in a Patient with Disseminated Intravascular Coagulation associated with Sepsis: Hyun Jin Baek, Doo Hyuk Lee, Kyu Hyung Han, Young Min Kim, Hyunbeom Kim, Byeongwook Cho, Inkuk Lee, Kanghyun Choi, Hojin Yong, Goohyeon Hong; Korean J Crit Care Med. 2016;31(2):134-139. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.134

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In critically ill patients, disseminated intravascular coagulation (DIC) is a common and fatal hematological disorder. DIC is a physiological response to a variety of underlying stimuli that provoke generalized activation of the hemostatic mechanism and is common in septic patients and those with hematological or non-hematological malignant neoplasms. Bleeding is a common clinical feature, and diffuse or multiple-site mucocutaneous bleeding, such as petechia, ecchymosis and hemorrhage from gastrointestinal tract, is often seen. A 58-year-old male was recently diagnosed with intracranial hemorrhage (ICH) caused by DIC associated with sepsis. Mortality of ICH caused by DIC is very high because the underlying condition cannot be quickly treated. Awareness of the possibility of DIC developing in a critically ill patient and the need for immediate initiation of plasma or platelet replacement therapy are important. To the best of our knowledge, this is the first reported case of intracranial hemorrhage in a Korean patient with DIC associated with sepsis.

Citations

Citations to this article as recorded by

Abdominal mass in a septic infant: Case of a fatal intraluminal intestinal hematoma
Mana Taweevisit, Paul Scott Thorner
Pediatric Hematology Oncology Journal.2021; 6(3): 139. CrossRef
Perforated Mesenteric Cyst with Sepsis and Neurological Complication in a 9 Month Old Child
Mandal KC, Saha D, Halder P, Chakraborty P, Debnath B, Mukhopadhyay B
Asploro Journal of Pediatrics and Child Health.2020; 2(1): 30. CrossRef

Cardiology/Neurology
Intracranial Hemorrhage Identified in the Early Stage after Applying Extracorporeal Membrane Oxygenation to Support Cardiopulmonary Resuscitation: Yong Hwan Kim, Kyoung Yul Lee, Seong Youn Hwang; Korean J Crit Care Med. 2014;29(3):197-200. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.197

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Abstract PDF: Extracorporeal membrane oxygenation support can extend the duration of cardiopulmonary resuscitation, but neurologic complications may develop. Cardiac arrest is a fairly common complication following severe intracranial hemorrhage; this complication is encountered both out-of-hospital and in-hospital with variable frequency. To prevent cerebral complications, to detect the cause of cardiac arrest, and to guide further treatment, early neuroimaging study is needed. Herein, we report a case of intracranial hemorrhage identified after extracorporeal cardiopulmonary resuscitation, in which the cause of the hemorrhage was not clear.

Original Article

Clinical Characteristics and Prognosis of Patients with Intracranial Hemorrhage during Mechanical Ventilation: Go Woon Kim, Jin Won Huh, Younsuck Koh, Chae Man Lim, Sang Bum Hong; Korean J Crit Care Med. 2012;27(2):94-101.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.94

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Abstract PDF: BACKGROUND
Intracranial hemorrhage is a serious disease associated with high mortality and morbidity, and develops suddenly without warning. Although there were known risk factors, it is difficult to prevent brain hemorrhage from critically ill patients in the intensive care unit (ICU). There are several reports that brain hemorrhage, in critically ill patients, occurred in connection with respiratory diseases. The aim of our study is to describe the baseline characteristics and prognosis of patients with intracranial hemorrhage during mechanical ventilation in the ICU.
METHODS
We retrospectively reviewed the medical records of 56 patients, who developed intracranial hemorrhage in a medical ICU, from May 2008 to December 2011. During the mechanical ventilation in the ICU, patients were implemented with a weaning process, following ACCP (American College of Chest Physicians) criteria. Also, we compared patients with brain hemorrhage to those without brain hemorrhage.
RESULTS
Thirty two of the 56 patients (57.1%) were male, and median ages were 63 (17-90) years. The common type of brain hemorrhage confirmed was intracerebral hemorrhage/intraventricular hemorrhage (52.2%). The duration from mechanical ventilation to brain hemorrhage was 6 (0-58) days. Overall hospital mortality was 57.1%, and ICU mortality was 44.6%. The most common cause of death was brain hemorrhage (40.6%). In comparison to patients without brain hemorrhage, study patients showed less use of anticoagulants and lower ventilator pressure. Our study showed that the use of vasopressor, systolic blood pressure, peak airway pressure, and platelet count were associated with brain hemorrhage.
CONCLUSIONS
Intracranial hemorrhage showed high mortality in critically ill patients with mechanical ventilation. In the future, large case-control study will be needed to evaluate the risk factors of cerebral hemorrhage.

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