A spontaneous cerebral hemorrhage case in the right temporal lobe in a patient with hemophilia C (XI factor deficiency)

A 28-year-old man was taken to our hospital with sudden onset of severe headache. The computed tomography (CT) scan revealed subcortical hemorrhage of the right temporal lobe. The patient has past medical history of hemophilia C (XI factor deficiency). On neurological examination no deficit was observed (Glasgow Coma Scale (GCS) -15). 10 hours after admission, his GCS and CT scan of the brain were unchanged. After consultation with the hematologist, he received fresh frozen plasma, mannitol, tranexamic acid during the treatment. But 36 hours after admission, the neurological status was worsened (GCS -12)․ A decision was made to immediately perform a temporal craniotomy with evacuation of intracerebral hematoma. Surgery and the postoperative period were uneventful․ The patient was discharged without neurological deficit․ This case highlights the importance of adequate preparation of the patient presurgically as much as possible to minimizes the risk of complications (rebleeding) during the operation and in the postoperative period.