PMC6121195_01
Patient 1. Platelet counts and platelet transfusions during intensive care hospitalization. Combined therapy including romiplostim as emergency management for severe immune thrombocytopenia complicated by intracranial hemorrhage (ICH). Intracranial pressure monitoring (ICPM); Romiplostim dose: 1 mug/kg subcutaneously; intravenous immunoglobulin (IVIg) dose: 1 g/kg; and high-dose methyl prednisolone (HDMP): 15 mg/kg/day.
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F1
Hospital for sepsis with eosinophilic pneumonia (Figures 1 and 2). His blood cell count revealed severe thrombocytopenia (31 x 109/L) with hypereosinophilia (8 x 109/L).
Patient 1. CT head (A,B,D) and CT venography (C) prior to surgery: (A) Day 6: large right frontal cerebral hematoma (40 mL), moderate mass effect with 4 mm of maximal brain midline shift. (B) Day 7: hematoma volume increase up to 45 mL. (C) Day 13: left lateral venous sinus thrombosis. (D) Day 14, just before surgery: increased mass effect (10 mm brain midline shift) with peripheral edema. CT head after surgery: (E) Day 16: decreased mass effect (6 mm brain midline shift).
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Hospital for sepsis with eosinophilic pneumonia (Figures 1 and 2). His blood cell count revealed severe thrombocytopenia (31 x 109/L) with hypereosinophilia (8 x 109/L). CT scan showed a large hemorrhage in the right frontal lobe (40 mL) with mass effect (Figure 2A) and a large (6 cm) left adrenal gland hematoma. CT angiography revealed a spot sign within the brain hematoma without any suggestion of arteriovenous malformation or cerebral venous thrombosis. A 24-h follow-up CT scan revealed a slight expansion of the frontal hematoma (45 vs. 40 mL) (Figure 2B). A brain CT venography showed a left lateral sinus thrombosis complicated by small temporal hemorrhage (Figure 2C). A new CT scan showed no expansion of the right frontal hematoma but substantial worsening of edema with increased mass effect (Figure 2D). No further hemorrhage expansion or new bleeding into the craniotomy site was noted on follow-up brain imaging (Figure 2E).
PMC6121195_02
Patient 2. Platelet counts and platelet transfusions during intensive care hospitalization. Combined therapy including romiplostim as emergency management for severe ITP complicated by intracranial hemorrhage (ICH). ICPM = intracranial pressure monitoring (intraparenchymal probe). MP = methylprednisolone. Romiplostim dose: 10 mug/kg subcutaneously; intravenous immunoglobulin (IVIg) dose: 1 g/kg.
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A 14-year-old female teenager, with a previous medical history of chronic ITP (diagnosed in 2012), was admitted to Mayotte's Hospital (French overseas department) in October 2015 for gingival bleeding, intense headaches, and drowsiness (Figures 3 and 4).
Patient 2. CT head (A,B) prior to surgery: (A) Day 1: 36 mL parieto-occipital hematoma with perilesional edema and slight mass effect. (B) Day 3: significant hematoma expansion (hematoma volume measured at 50 mL) and increased mass effect. CT head (C-E) after surgery: (C) Day 5; the day after surgery: hematoma evacuation; decreased mass effect; subcutaneous hematoma occurring during surgery. (D) Day 10: no rebleeding was noted. (E) Day 10: no hemorrhage was observed around the intraparenchymal probe (intracranial pressure monitoring).
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A 14-year-old female teenager, with a previous medical history of chronic ITP (diagnosed in 2012), was admitted to Mayotte's Hospital (French overseas department) in October 2015 for gingival bleeding, intense headaches, and drowsiness (Figures 3 and 4). A CT scan showed a 36 mL right parieto-occipital hematoma with significant perilesional edema and mass effect (Figure 4A). After admission, the neurological status of the patient deteriorated, with coma and anisocoria related to cerebral hematoma growth (50 mL) (Figure 4B). Despite massive platelet transfusion in the perioperative period, the PC remained below 15 x 109/L before the procedure, which was complicated by significant subcutaneous bleeding (Figure 4C). No further hemorrhage expansion or new bleeding into the craniotomy site was noted on follow-up brain imaging (Figure 4D). ICP monitor (Figure 4E) placed at the end of the surgical procedure. ICP was initially measured at 27 mmHg and then decreased gradually by continuing sedation for a few more days.