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Guarding against the storm: the imperative of early intracranial hemorrhage recognition in end-stage renal disease and hypertension: a case report

MOJ Clinical & Medical Case Reports
Karam Rabi,<sup>1,2</sup> Shams Alhammouri,<sup>2</sup> Shadi Saa<sup>2</sup>

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Intracranial hemorrhage (ICH) is a critical neurological event, often associated with uncontrolled blood pressure. While hypertension may arise from various underlying factors, it is nearly always linked to renal pathology, and end-stage renal disease (ESRD) in particular, forming a robust connection. This connection further underscores the intricate relationship between ESRD and hypertension, particularly concerning the development of intracranial hemorrhage in affected patients. We present a case of a 55-year-old male who initially arrived at the emergency department with a sudden, severe headache, recurring episodes of vomiting, and a swift progression into confusion. A non-contrast brain CT scan revealed a notable area of increased density within the brain parenchyma, signifying a substantial intraparenchymal hemorrhage on the right side. The hemorrhage has consequently resulted in a midline shift, measuring approximately 9 millimeters. The patient’s surgical intervention proceeded without any complications. Postoperatively, the patient showed remarkable improvement compared to his initial presentation. The association between end-stage renal disease (ESRD), hypertension, and intracranial hemorrhage highlights the importance of vigilance among emergency physicians. Recognizing the connection between these factors can aid in the early diagnosis and management of intracranial hemorrhage in ESRD patients, potentially improving outcomes and reducing complications. This case report serves as a reminder of the need for heightened awareness and timely intervention in such cases.


ICH, hemorrhage, ESRD, hypertension, brain, emergency