A complex case of recurrent intracranial bleeds due to malaria-induced coagulopathy: A case report and literature review.

Surgical neurology international Pub Date : 2024-08-30 eCollection Date: 2024-01-01 DOI:10.25259/SNI_553_2024
Syeda Mahrukh Fatima Zaidi, Ayesha Amjad, Kainat Sohail, Faizan Ur Rehman
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Abstract

Background: Malaria, a prevalent disease in the developing world, is a significant cause of morbidity and mortality. Infection with Plasmodium falciparum, although uncommon, can lead to severe brain injury, including intracranial hemorrhages, resulting in serious neurological deficits. Malaria-induced coagulopathy, while rarely reported, poses a challenge in understanding the exact mechanisms behind the development of intracranial bleeds. Proposed mechanisms include sequestration of parasitized erythrocytes in the brain's microvasculature, leading to capillary occlusion, endothelial damage, cytokine activation, and dysregulation of the coagulation cascade.

Case description: We present the case of a 53-year-old male rapidly deteriorating following a history of traumatic brain injury (TBI). Upon admission, a computed tomography scan revealed bilateral acute on chronic hematomas, necessitating a lifesaving craniotomy. Subsequently, the patient experienced three consecutive recurrent intracranial bleeds post-surgery, attributed to Falciparum-induced coagulopathy. Prompt recognition and intervention stabilized the patient's condition, leading to discharge on the 4th post-operative day.

Conclusion: This case underscores the challenges posed by consecutive recurrent intracranial bleeds following TBI exacerbated by P. falciparum infection. It highlights the obstinate nature of malaria-induced coagulopathy and underscores the importance of timely and aggressive interventions in managing such cases.

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疟疾诱发凝血功能障碍导致颅内反复出血的复杂病例:病例报告和文献综述。
背景:疟疾是发展中国家的一种流行病,是发病和死亡的重要原因。感染恶性疟原虫虽然并不常见,但可导致严重的脑损伤,包括颅内出血,造成严重的神经功能障碍。疟疾诱发凝血病的报道很少,但这对了解颅内出血发生的确切机制提出了挑战。拟议的机制包括寄生在大脑微血管中的红细胞固着,导致毛细血管闭塞、内皮损伤、细胞因子激活和凝血级联调节失调:本病例是一名 53 岁的男性,因脑外伤(TBI)而导致病情迅速恶化。入院时,计算机断层扫描发现双侧急性和慢性血肿,必须进行开颅手术以挽救生命。随后,患者在手术后连续出现三次复发性颅内出血,原因是法氏疟原虫诱发的凝血功能障碍。及时的识别和干预稳定了患者的病情,使其在术后第 4 天出院:本病例强调了因恶性疟原虫感染而加重的创伤性脑损伤后连续复发性颅内出血所带来的挑战。它凸显了疟疾诱发的凝血病的顽固性,并强调了及时、积极干预对处理此类病例的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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