Management of Spontaneous frontal epidural and subarachnoid hemorrhage in a sickle cell patient: A tragic end

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AuteurMfouapon Ewane HB
Auteurs associésHIMMICHEM, Segbedi F
RevueInterdisciplinary Neurosurgery
Référence Revue3:17-18


Sickle cell disease (SCD) is an autosomal recessive disease common in Sub-Saharan Africa and Mediterranean countries. It appears from a homozygous form (HbSS) of the sickle cell trait. Hemorrhagic cerebrovascular accidents (CVA) make up 25% of CVA in SCD. Subarachnoid hemorrhages (SAH) are less common and epidural hematoma (EH) rare [1]. About 13 cases of spontaneous EH in sickle cell disease have been reported in English literature. An association with vaso-occlusive crises and skull infarction were observed in the few reported cases [2].We report a case of spontaneous EH and SAH in a 20 year old known SCD, Morrocan (HbSS) admitted in our department

Case report

A 20 year old patient known to have sickle cell anemia (SCA) with recurrent episodes of vaso occlusive crisis (VOS) presented to the emergency after a 4 day history of generalised joint pains. Symptoms deteriorated with rapidly progressive altered consciousness and headache. No histories of head trauma nor anti-platelet drug were reported

At the emergency, he had a Glasgow Coma Scale(GCS) of 10, with right anisocoria. He had tachycardia of 124 beats/minute. Temperature was 38.5 °C and blood pressure was 150/88 mmHg. We noted a fluctuant mass on the left parietal region. Work-up exams showed:hemoglogin 12.9 g/dl, leukocytosis of 21,830/μL with 15,750 neutrophils, platelets 151,000/μL, C reactive protein (C.R.P) 303 mg/L, normal urea, creatinine and electrolytes values. Urine exam culture was normal. Chest X ray was normal. Blood culture was conducted and we gave a broad spectrum antibiotic with a third generation cephalosporin. A rapid head CT (Fig. 1) scan showed bilateral frontal epidural haematoma with subarachnoid hemorrhage in the anterior interhemispheric scissure and sub-galeal hemorrhage