Intracranial bleeding in haemophilia beyond the neonatal period - the role of CT imaging in suspected intracranial bleeding

Authors: TRAIVAREE, C.¹; BLANCHETTE, V.¹; ARMSTRONG, D.²; FLOROS, G.³; STAIN, A. M.³; CARCAO, M. D.¹

Source: Haemophilia, Volume 13, Number 5, September 2007 , pp. 552-559(8)

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Abstract:

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.

Keywords: computed tomography; intracranial haemorrhage; haemophilia; head trauma; neurological impairment; paediatrics; radiology

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1365-2516.2007.01545.x

Affiliations: 1: Division of Haematology/Oncology, Department of Paediatrics 2: Department of Diagnostic Imaging 3: Department of Nursing, The Hospital for Sick Children, University of Toronto, Toronto, Canada

Publication date: 2007-09-01

Intracranial bleeding in haemophilia beyond the neonatal period - the role of CT imaging in suspected intracranial bleeding

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