Adult ; Afibrinogenemia ; chemically induced ; Humans ; Intracranial Hemorrhages ; chemically induced ; Male ; Valproic Acid ; adverse effects

Aged ; Anticoagulants ; adverse effects ; Aspirin ; adverse effects ; Fatal Outcome ; Female ; Humans ; Intracranial Hemorrhages ; chemically induced ; Male ; Postoperative Hemorrhage ; chemically induced ; Risk Factors

Stroke classified into ischemic and hemorrhagic subtypes, is among the most devastating diseases for human being. Certain drugs could increase the blood viscosity, thereby increasing the potential risk of ischemia. Anti-platelet and anti-coagulation drugs, as the treatment of first choice, increase the risk of intracranial hemorrhage and death. Here, we are the first to propose the concept of drug-related stroke, and discuss the treatment strategy for patients who are complicated with intracranial hemorrhage or plan to receive neurosurgical operation during either anti-platelet or anti-coagulation medication. We hope to arouse the attention for drug related stroke among the clinicians and offer recommendation for clinical intervention.
Drug-Related Side Effects and Adverse Reactions ; pathology ; Humans ; Intracranial Hemorrhages ; complications ; Stroke ; chemically induced ; prevention & control ; therapy

A 27-yr-old woman who had been taking warfarin for 10 yr after mitral valve replacement became pregnant. After knowing her pregnancy, she received heparinization for nine weeks instead of warfarin, and took oral anticoagulant again. At 24 weeks of gestation, fetal ultrasound and MRI showed a left subdural hematoma, and the pregnancy was terminated. Subdural hematoma was demonstrated on autopsy. Fatal bleeding of the fetus is a rare complication of maternal warfarin medication, occurring mostly in the second or third trimester. There is no alternative regimen available, so that regular monitoring by fetal ultrasound and strict control of warfarin dose with regular measurement of prothrombin time are the best way to prevent intrauterine fetal death due to bleeding.
Adult ; Anticoagulants/*adverse effects ; Ductus Arteriosus, Patent/surgery ; Female ; Fetal Diseases/*chemically induced ; Heart Valve Diseases/therapy ; Hematoma/chemically induced ; Heparin/adverse effects ; Human ; Intracranial Hemorrhages/*chemically induced ; Maternal Exposure ; Pregnancy ; Pregnancy Complications, Hematologic ; Prothrombin Time ; Warfarin/*adverse effects

A patient received combined spinal-epidural anesthesia for a scheduled total knee arthroplasty. After an injection of spinal anesthetic and ephedrine due to a decrease in blood pressure, the patient developed a severe headache. The patient did not respond to verbal command at the completion of the operation. A brain CT scan revealed massive subarachnoid and intraventricular hemorrhages, and a CT angiogram showed a ruptured aneurysm. Severe headaches should not be overlooked in an uncontrolled hypertensive patient during spinal anesthesia because it may imply an intracranial and intraventricular hemorrhage due to the rupture of a hidden aneurysm.
Aged ; Anesthesia, Epidural/*adverse effects ; Anesthesia, Spinal/*adverse effects ; Aneurysm, Ruptured/*chemically induced/*complications ; Cerebral Ventricles/*physiopathology ; Humans ; Intracranial Hemorrhages/*etiology ; Male ; Subarachnoid Hemorrhage/*etiology