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Hypofibrinogenemia Presenting as Intracranial Hemorrhage

Sreenivasa rao Sudulagunta, Hadi Khorram, Mahesh Babu Sodalagunta, Mona Sepehrar, Mohammed Aheta Sham, Zahra Noroozpour

Abstract


Introduction: Factor I deficiency or fibrinogen deficiency, is a rare inherited bleeding disorder related to fibrinogen function in the blood coagulation cascade. They are classified into afibrinogenemia, hypofibrinogenemia and dysfibrinogenemia. Afibrinogenemia is defined as a lack of fibrinogen in the blood, i.e. <20 mg/dl of plasma with a frequency between 0.5 and 2 per million. Hypofibrinogenemia is partial deficiency of fibrinogen with levels of 20–80 mg/dl of plasma. Estimated frequency varies from 0.5 to 3 per million.

Case Report: We report regarding a 46 year old female patient, who presented with complaints of severe headache and right sided weakness. Examination revealed right Hemiplegia with BP of 144/90 mm Hg. Investigations revealed Creatine Kinase: 470IU/L, normal Blood counts, ESR and CRP. Thyroid profile was normal. Fibrinogen levels were 17.9mg/dl and repeat test after 1 week showed 24.6mg/dl. ECG showed incomplete left bundle branch block. Echocardiography was normal.

Conclusion: Hypofibrinogenemia rarely manifests as intracranial hemorrhage but, commonly presents with oral, mucosal and gastro intestinal tract bleeding. 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.


Keywords


Hypofibrinogenemia; Intracranial hemorrhage; left bundle block

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