Bleeding inside the head is a common cause of death in persons with hemophilia. Bleeding may occur spontaneously or as a result of injuries, which may be slight, such as a minor fall or bump on the head. Symptoms of brain hemorrhage may not occur until several days after injury and include irritability, drowsiness, headache, confusion, nausea, vomiting and double vision. Medical attention should be sought immediately.
Signs and Symptoms:
Some of the warning signs, such as a seizure or loss of consciousness, are unmistakable, and such obvious indicators are not apparent. Sometimes the signals are mild enough that one could confuse them with symptoms of flu or gastrointestinal upset:
• A persistent headache that does not respond to analgesics;
• Confusion and difficulty in concentrating
• Drowsiness, Dizziness and stiff neck.
• Changes in behavious, lethargy, strange gait, slurred speech, visual problems (double vision) or sudden forceful vomiting.
Management:
• Rush to nearest hemophilia treatment center
• Infuse factor concentrates to
100% for factor VIII - 50 units/kg
60% for factor IX - 60 units/kg
• CT scan to confirm diagnosis
• If bleed is confirmed, continue factors for 72 hours.
Factor VIII - 25 units/kg every 8 hrs
Factor IX - 50 units/kg every 12 hrs
Thereafter depending on the individual clinical condition, factor infusion is to continue for the next 7-10 days
• Treatment to control fits should be started and continued for atleast 6 months
Any head bleed is life-threatening, so even at the suspicion of one, infuse immediately, notify treatment centres and get to an emergency room
Rapidity of treatment helps a lot in preventing complications. For instance, a young patient who had a mild head trauma (intracranial bleed) was treated so quickly that he did not suffer from neurological problems.