Rapid Progresses of the Cerebellar Hemorrhage During Anticoagulant Therapy
基本信息 Basic Information
男，75岁
75-year-old male
症状：头晕、呕吐、共济失调
Symptoms: dizziness, vomiting and ataxia
房颤和高血压史
History of atrial fibrillation and hypertension
华法林抗凝治疗，INR：4.62
Anticoagulant therapy using warfarin, INR: 4.62.
2011-07-05 21:07
△头颅CT平扫：左侧小脑出血，血肿密度不均匀
△Cranial CT showed a left cerebellar hemorrhage; there were multiple small zones of equal density within the hyperdensive hematoma.
尽管予以维生素K、新鲜冰冻血浆、甘露醇等治疗，但患者病情逐渐加重，最终昏迷。
This patient received treatments of vitamin K, fresh frozen plasma, mannitol and so on, but his condition gradually worsened and finally became comatose.
2011-07-06 02:59
△头颅CT平扫：左侧小脑出血明显增大，占位效应明显，幕上脑积水。
△Cranial CT showed a rapid progresses of the left cerebellar hemorrhage with a significant space-occupying and a supratentorial hydrocephalus.
出血是华法令抗凝最常见，也是医生和患者最为担心的并发症；多发生于胃肠道；治疗上一般予以维生素K、新鲜冰冻血浆和维持生命体征稳定等。
但和华法令相关的脑出血则是一严重疾病，由于脑血肿难以凝结，故无法起到压迫止血作用，出血早期血肿可能持续增大，最终导致严重后果。本病例即是如此。
华法令的抗凝作用受很多因素的影响，如药物和食物。华法令抗凝患者需在饮食和药物方面接受专业医生指导，且要定期监测INR，根据结果调整剂量，以免因抗凝不足而发生血栓事件，或抗凝过度而增加出血风险。
