Researchers report regarding a 46 year old female patient, who presented with complaints of severe headache and right sided weakness. Examination revealed right Hemiplegia. ECG showed incomplete left bundle branch block.
Patients admitted with stroke should be evaluated for fibrinogen deficiency and more emphasis to be laid in case of intracranial hemorrhage and previous history of bleeding.
A 46 year-old woman was bought to Emergency room with sudden loss of consciousness, left sided weakness of body and history of headache. As GCS was 5/15. History from husband revealed headache, epistaxis, cough with expectoration and shortness of breath from 4 days for which she was admitted in local clinic.
Babinski’s reflex was elicited on right side. Chest Radiography showed alveolointerstitial infiltrate in right basal area. CT of Brain revealed intracranial hemorrhage in the left cerebral hemisphere extending into ventricles. Patient had history of 3 times abortion in 4th, 6th and 8th months of pregnancy. Investigations showed fibrinogen level of 17.9 mg/dl, Factor VIII 120.2%, PT > 2 minutes, APTT > 3 minutes, TT 33.8 sec. History from relatives revealed that her father had similar bleeding episodes and death due to intracranial hemorrhage.
Patient was given fibrinogen concentrate to maintain level more than 0.8g/l. Fibrinogen concentrate is available as a powder to be dissolved in 50 ml of water and be given as a slow IV injection. The advantages of fibrinogen concentrate over cryoprecipitate are that it has less viral transmission, less immunogenic, lesser thromboembolism events.5 Condition of patient improved over a period of 3 days with no requirement of mechanical ventilation. Patient was shifted to medical ward after a period of 7 days. Patient was advised physiotherapy and monitoring of fibrinogen levels.
Hypofibrinogenemia is a rare disease occurring almost 1 in 1 million. Fibrinogen replacement therapy is effective in preventing hemorrhage along with continuous monitoring of fibrinogen levels. Patients admitted with stroke should be evaluated for fibrinogen deficiency and more emphasis to be laid in case of intracranial hemorrhage and previous history of bleeding.
Source: JAPI, India