Dichotomous interpretations and a stroke of luck: A case of silent cerebral hemorrhage

Abstract

“Silent Cerebral Hemorrhage” in a young alcohol-dependent individual can pose a significant challenge to the treating physician. The neuroimaging and clinical presentation maybe dichotomous to a critical extent.Our aim was to explore the scientific understanding of “Silent Cerebral Hemorrhage” and share the wisdom gathered about the diagnosis and management of this rare entity. A 32-year-old male presented with fever and episodes of vomiting alongwith urinary incontinence, in the backdrop of heavy alcohol abuse. Detailed neurological assessment revealed no abnormal findings. MMSE indicated towards no significant cognitive deficits. On MRI, an extensive intracerebral hemorrhage was observed.The I.C.H. score was 2/6 and the FUNC score was 8/11; which was in stark contrast to NIH Stroke Scale score of 0/42.Blood-panel showed deranged liver enzymes. Patient was managed conservatively. Irritability was controlled using Haloperidol. Prophylactic antiepileptics were also started.Upon follow-up, patient showed drastic improvement. Patient was started on Acamprosate for maintenance of abstinence.Through this case report we have tried to highlight that “Silent Cerebral Hemorrhage” can present as a curve-ball for clinicians and psychiatrists. The dichotomy in interpretation of stroke-related scales may cause a dilemma about the course of management.“In this case, the absence of neurological deficits was indeed a stroke of luck for the patient.”: “Silent Cerebral Hemorrhage” can present as a curve-ball for clinicians and psychiatrists. Hence, we should be vigilant about it in our clinical practice. The dichotomy in interpretation of stroke-related scales may cause a dilemma about the course of management.