Challenges in Perioperative management of spontaneous acute subdural hematoma in haemophilia patients

• Published in: Nepal journal of neuroscience Vol. 19; no. 4; pp. 70 - 73
• Main Authors: Gautam, Sachidanand, Singhal, Manoj, Panchariya, Piyush Kumar, Acharya, Jigmisha
• Format: Journal Article
• Language: English
• Published: 31-12-2022
• ISSN: 1813-1948; 1813-1956
• DOI: 10.3126/njn.v19i4.38185

Intracranial hemorrhage in patients with hemophilia is associated with high mortality and morbidity. We report a case of 15 years old boy with haemophilia A, who presented with a spontaneous acute subdural hematoma and underwent craniotomy for clot evacuation. The patient also received Factor VIII infusions peri-operatively along with other measures, to decrease blood loss.
The patient presented with signs of raised intracranial pressure and received mannitol intra-operatively and postoperatively to prevent brain edema. Hypertonic saline (3 ml/kg of 3% solution) was also given over 30 minutes for brain relaxation. Recommendations for peri-operative preparation and management of haemophilia, especially in the setting of emergency major surgery were also reviewed.