Desafíos en hemorragia cerebral y cirrosis hepática. derivación ventricular bilateral como alternativa terapéutica

Abstract

Objective

To describe the management of a patient with intraparenchymal hematoma, intraventricular hemorrhage (IVH) and coagulopathy secondary to liver cirrhosis; exploring bilateral ventricular shunt (bVSD) placement as a therapeutic option.

Case report

40-year-old man with liver cirrhosis and severe coagulopathy, found in coma and with multiple hemorrhagic brain lesions secondary to traumatic brain injury, as well as IVH and obstructive hydrocephalus. Despite the coagulopathy, an bVSD system was placed and used for ventricular lavage, achieving temporary control of intracranial pressure (ICP).

Results

Although temporary stabilization of ICP was achieved, the patient's evolution was unfavorable, basically influenced by the complex scenario of recurrent coagulopathy despite corrective measures, repeated obstruction of the DVEb, new hemorrhaging and the impossibility of performing other types of interventions. Finally, and as a consequence, limitation of therapeutic effort was performed.

Conclusions

DVEb placement may be a useful alternative to manage IVH in patients with severe coagulopathy, although long-term results still require further evaluation. This case illustrates the complexity of management in these patients and the need for further studies regarding this procedure.