Multiple intracranial aneurysms with factor VII deficiency
The present case has been reported in the Asian Journal of Neurosurgery.

A 55-year-old postmenopausal female was admitted in neurosurgery department with sudden onset of headache followed by vomiting and loss of consciousness. On examination, the patient was unconscious. She did not have eye opening on pain, no verbal response and localizing on painful stimulus (Glasgow coma scale [GCS] E1V1M5).

Patient was urgently intubated and taken for the CT scan of the brain that revealed subarachnoid hemorrhage (Fisher Grade 4) in bilateral sylvian fissure and suprasellar cistern with intraventricular extension. CT Angiography of the brain revealed multiple aneurysms, and to the authors' surprise, there were ten aneurysms including basilar top, both posterior communicating artery, anterior communicating artery, both middle cerebral artery bifurcation, bilateral distal anterior cerebral artery, and bilateral distal MCA aneurysm.

Coagulation profile revealed prolonged prothrombin time with normal activated partial thromboplastin time. Blood serum level of Factor VII was 18%. Patient was treated with ventilator with antiepileptics, intravenous nimodipine, and mannitol. Transfusion of recombinant Factor VII was done. Repeat CT scan did not reveal any evidence of hydrocephalus. Patient was advised for coiling of aneurysms but before the authors could perform definitive treatment patient had a re-bleed and her GCS response become E1V1M1.

Repeat CT scan of the brain revealed multiple infract in the brain with hydrocephalus for that external ventricular drain insert. In spite of all the efforts patient could not be saved and died on 3 days after admission.

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