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Intracerebral Hemorrhage from Anticoagulation

A 77 year-old man developed paralysis of the right arm followed by a headache and obtundation. He was being treated with intravenous heparin for a deep venous thrombosis, with a PTT of 127 seconds when he became symptomatic.

Outline the Hemorrhage          Note the "Fluid-Fluid" Levels          Note the Midline Shift

Lobar Intracerebral Hemorrhage from Anticoagulation: Axial CT scans. Note the multiple intracerebral hemorrhages in the left hemisphere. Several have fluid-fluid levels wherein the cells in the blood have separated out and layered below the plasma. Spontaneous intracerebral hemorrhages can occur from coagulopathies, including excessive anticoagulation.

Revised 11/30/06.
Copyrighted 2006. David C Preston