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
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Karam Rabi,<sup>1,2</sup> Shams Alhammouri,<sup>2</sup>
Shadi
Saa<sup>2</sup>
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Abstract
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.
Keywords
ICH, hemorrhage, ESRD, hypertension, brain, emergency
