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Intracranial bleeding in haemophilia beyond the neonatal period – the role of CT imaging in suspected intracranial bleeding
Author(s) -
TRAIVAREE C.,
BLANCHETTE V.,
ARMSTRONG D.,
FLOROS G.,
STAIN A. M.,
CARCAO M. D.
Publication year - 2007
Publication title -
haemophilia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.213
H-Index - 92
eISSN - 1365-2516
pISSN - 1351-8216
DOI - 10.1111/j.1365-2516.2007.01545.x
Subject(s) - medicine , haemophilia , intracranial haemorrhage , intracranial bleeding , haemophilia a , presentation (obstetrics) , pediatrics , computed tomographic , radiology , surgery , computed tomography , complication , anticoagulant
Summary. We conducted a review of a single institutional experience of patients with haemophilia presenting with suspected intracranial haemorrhage (ICH) who underwent computed tomographic (CT) neuro‐imaging. We found that over a 9‐year period (1996–2004) 43 patients with haemophilia presented 73 times with suspected ICH: 10 presented multiple times (range: 2–9 times). The median age at presentation was 3.5 years (range: 0.5–17). Preceding trauma occurred in most (62/73; 85%) episodes. ICH was confirmed in 11 of the 73 (16%) episodes in eight patients. Patients with severe haemophilia accounted for a disproportionate number of episodes of suspected (60/73; 82%) and of confirmed ICH (10/11; 91%). All ICH occurred in patients not on prophylaxis; five occurred in three inhibitor‐positive patients. Altered consciousness at presentation was present in 10/11 (91%) cases of confirmed ICH but only in 5/62 (8%) (ICH‐negative) episodes. The positive and negative predictive values of altered consciousness to predict/rule out an ICH was 67% and 98%, respectively. The following were associated with an increased risk of presenting with suspected ICH and of having a confirmed ICH: (i) having severe haemophilia; (ii) not being on prophylaxis; (iii) having an inhibitor; and (iv) presenting with an altered level of consciousness. Patients without any of these features may not need to undergo CT imaging when presenting with suspected ICH. Ideally a prospective study to evaluate this hypothesis should be conducted.