Acute Subdural Hematoma In A Patient With Hemophilia A: Case Report

Abstract

Background: Intracranial hemorrhage (ICH) is a rare but life-threatening complication in patients with hemophilia, with a markedly higher incidence than in the general population. Even minor head trauma can precipitate severe bleeding, particularly in the absence of prophylactic therapy.

Case: A 6-year-old boy with moderate hemophilia A (factor VIII ~1.2%) developed an acute subdural hematoma (SDH) after minor head injury. He presented with progressive headache, vomiting, and decreased consciousness. Laboratory evaluation showed prolonged activated partial thromboplastin time consistent with factor VIII deficiency. Immediate factor VIII replacement was administered according to World Federation of Hemophilia (WFH) guidelines, along with adjunctive tranexamic acid. Cranial computed tomography revealed a large SDH with significant midline shift. The patient underwent emergent decompressive hemicraniectomy and hematoma evacuation with meticulous perioperative hemostatic management. Postoperatively, intensive care monitoring and sustained factor replacement maintained adequate hemostasis, resulting in stabilization and full neurological recovery without deficits.

Conclusion: This case demonstrates that life-threatening ICH can occur even in moderate hemophilia following trivial trauma. Early recognition, prompt factor replacement, and coordinated multidisciplinary management are critical to improving survival and neurological outcomes.